Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study
<p>Abstract</p> <p>Background</p> <p>The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA).</p> <p>Methods</p> <p>In a prospective study we screened for PA in a non-selected (NSP)...
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| Format: | Article |
| Language: | English |
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BMC
2012-09-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | http://www.biomedcentral.com/1472-6823/12/17 |
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| author | Sigurjonsdottir Helga Gronowitz Mikael Andersson Ove Eggertsen Robert Herlitz Hans Sakinis Augustinas Wangberg Bo Johannsson Gudmundur |
| author_facet | Sigurjonsdottir Helga Gronowitz Mikael Andersson Ove Eggertsen Robert Herlitz Hans Sakinis Augustinas Wangberg Bo Johannsson Gudmundur |
| author_sort | Sigurjonsdottir Helga |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA).</p> <p>Methods</p> <p>In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral.</p> <p>Results</p> <p>After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation.</p> <p>Conclusion</p> <p>The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.</p> |
| first_indexed | 2024-12-11T17:43:36Z |
| format | Article |
| id | doaj.art-6817ac8226da4aa89708b2bb56b5f2da |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-12-11T17:43:36Z |
| publishDate | 2012-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Endocrine Disorders |
| spelling | doaj.art-6817ac8226da4aa89708b2bb56b5f2da2022-12-22T00:56:27ZengBMCBMC Endocrine Disorders1472-68232012-09-011211710.1186/1472-6823-12-17Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening studySigurjonsdottir HelgaGronowitz MikaelAndersson OveEggertsen RobertHerlitz HansSakinis AugustinasWangberg BoJohannsson Gudmundur<p>Abstract</p> <p>Background</p> <p>The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA).</p> <p>Methods</p> <p>In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral.</p> <p>Results</p> <p>After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation.</p> <p>Conclusion</p> <p>The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.</p>http://www.biomedcentral.com/1472-6823/12/17Endocrine hypertensionHyperaldosteronismAldosteroneReninHypertensionResistant hypertensionAdrenal hyperplasia |
| spellingShingle | Sigurjonsdottir Helga Gronowitz Mikael Andersson Ove Eggertsen Robert Herlitz Hans Sakinis Augustinas Wangberg Bo Johannsson Gudmundur Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study BMC Endocrine Disorders Endocrine hypertension Hyperaldosteronism Aldosterone Renin Hypertension Resistant hypertension Adrenal hyperplasia |
| title | Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study |
| title_full | Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study |
| title_fullStr | Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study |
| title_full_unstemmed | Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study |
| title_short | Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study |
| title_sort | unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism results from a swedish screening study |
| topic | Endocrine hypertension Hyperaldosteronism Aldosterone Renin Hypertension Resistant hypertension Adrenal hyperplasia |
| url | http://www.biomedcentral.com/1472-6823/12/17 |
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