DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214792

Hyperaldosteronism: types, clinical characteristics, and treatment

Areej M. Alsyamy, Amnah T. Kashkari, Fawaz A. Alazdi, Abdulmonem T. Dalati, Mohammed M. Alawadi, Emad S. Hawari, Mohammed M. Nassar, M. Mohanad I. A. Hennawi, Hassan H. Alaslani, Ashjan A. Albayshi, Mohammed L. Fatani

Abstract


Cases with hyperaldosteronism might be asymptomatic in many events. Therefore, the diagnosis can be missed. However, the usual presentation for many patients has been reported to be a refractory elevation in the blood pressure which might be mild to severe. Based on the type of hyperaldosteronism and the diagnosis, the treatment of these conditions should be established. Therefore, it can be concluded that the treatment is specific to the management of the underlying etiology, and managing the clinical characteristics and associated complications. This present literature review aims to provide evidence regarding the types, clinical characteristics, and treatment of aldosterone based on data from the current investigations in the literature. Different clinical phenotypes have been reported for the condition. Nevertheless, the disease can be broadly classified into primary and secondary hyperaldosteronism based on the pathophysiology and etiology of the condition. Clinical characteristics might not be diagnostic since they are very non-specific, despite being common in these patients, as hypokalemia and hypertension. Therefore, clinicians should be aware of conducting the necessary diagnostic approaches before establishing the diagnosis. Management of these patients requires the integration of different approaches, including surgical and medical treatment. Perioperative care is important because it may lead to unfavorable consequences if neglected.


Keywords


Hyperaldosteronism, Conn syndrome, Mineralocorticoids, Adrenal hyperplasia, Renal artery stenosis, Aldosterone, Treatment, Clinical presentation

Full Text:

PDF

References


Scholl UI. Hyperaldosteronismus. Der Internist. 2021;62(3):245-51.

Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. Arch Endocrinol Metabol. 2017;61(3):305-12.

Chikladze NM, Favorova OO, Chazova IE. Family hyperaldosteronism type I: a clinical case and review of literature. Terapevticheskii arkhiv. 2018;90(9):115-22.

Stowasser M, Wolley M, Wu A, et al. Pathogenesis of Familial Hyperaldosteronism Type II: New Concepts Involving Anion Channels. Curr Hypertens Rep. 2019;21(4):31.

Pons Fernández N, Moreno F, Morata J. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocrine Metabol Disord. 2019;20(1):27-36.

Corssmit EPM, Dekkers OM. Screening in adrenal tumors. Curr Opinion Oncol. 2019;31(3):243-6.

Morera J, Reznik Y. Management Of Endocrine Disease: The role of confirmatory tests in the diagnosis of primary aldosteronism. Eur J Endocrinol. 2019;180(2):45-58.

Nishimoto K, Nakagawa K, Li D, et al. Adrenocortical zonation in humans under normal and pathological conditions. J Clin Endocrinol Metabol. 2010;95(5):2296-305.

Nanba K, Vaidya A, Williams GH, Zheng I, Else T, Rainey WE. Age-Related Autonomous Aldosteronism. Circulation. 2017;136(4):347-55.

Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism. World J Surg. 2005;29(2):155-9.

Streeten DH, Tomycz N, Anderson GH. Reliability of screening methods for the diagnosis of primary aldosteronism. Am J Med. 1979;67(3):403-13.

Prejbisz A, Warchoł-Celińska E, Lenders JW, Januszewicz A. Cardiovascular Risk in Primary Hyperaldosteronism. Hormone Metabol Res. 2015;47(13):973-80.

Papadopoulou-Marketou N, Vaidya A, Dluhy R, Chrousos GP. Hyperaldosteronism. In: Feingold KR, Anawalt B, Boyce A, editors. Endotext. South Dartmouth (MA): MDText.com, Inc. 2000.

Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med. 2001;344(6):431-42.

Conn JW, Cohen EL, Lucas CP. Primary reninism. Hypertension, hyperreninemia, and secondary aldosteronism due to renin-producing juxtaglomerular cell tumors. Arch Internal Med. 1972;130(5):682-96.

Safian RD. Atherosclerotic Renal Artery Stenosis. Curr Treatment Options Cardiovasc Med. 2003;5(2):91-101.

Funder JW, Carey RM, Fardella C. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol. 2008;93(9):3266-81.

Vaidya A, Underwood PC, Hopkins PN. Abnormal aldosterone physiology and cardiometabolic risk factors. Hypertension. 2013;61(4):886-93.

Baudrand R, Guarda FJ, Torrey J, Williams G, Vaidya A. Dietary Sodium Restriction Increases the Risk of Misinterpreting Mild Cases of Primary Aldosteronism. J Clin Endocrinol Metabol. 2016;101(11):3989-96.

Markou A, Pappa T, Kaltsas G. Evidence of primary aldosteronism in a predominantly female cohort of normotensive individuals: a very high odds ratio for progression into arterial hypertension. J Clin Endocrinol Metabol. 2013;98(4):1409-16.

Brown JM, Underwood PC, Ferri C. Aldosterone dysregulation with aging predicts renal vascular function and cardiovascular risk. Hypertension. 2014;63(6):1205-11.

Kono T, Ikeda F, Oseko F, Imura H, Tanimura H. Normotensive primary aldosteronism: report of a case. J Clin Endocrinol Metabol. 1981;52(5):1009-13.

El-Qushayri AE, Ghozy S, Reda A, Kamel AMA, Abbas AS, Dmytriw AA. The impact of Parkinson's disease on manifestations and outcomes of Covid-19 patients: A systematic review and meta-analysis. Rev Med Virol. 2021;2278.

Mulatero P, Stowasser M, Loh KC. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metabol. 2004;89(3):1045-50.

Nehs MA, Ruan DT. Minimally invasive adrenal surgery: an update. Curr Opinion Endocrinol Diabetes Obesity. 2011;18(3):193-7.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva Medica. 2020;111(5):498-501.

Liu SY, Chu CC, Tsui TK. Aldosterone-producing Adenoma in Primary Aldosteronism: CT-guided Radiofrequency Ablation-Long-term Results and Recurrence Rate. Radiology. 2016;281(2):625-34.

Sarwar A, Brook OR, Vaidya A. Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy. J Vasc Intervent Radiol. 2016;27(7):961-7.

Yang MH, Tyan YS, Huang YH, Wang SC, Chen SL. Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma. La Radiologia medica. 2016;121(10):811-9.

Keeling AN, Sabharwal T, Allen MJ, Hegarty NJ, Adam A. Hypertensive crisis during radiofrequency ablation of the adrenal gland. J Vasc Intervent Radiol. 2009;20(7):990-1.

Funder JW, Carey RM, Mantero F. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metabol. 2016;101(5):1889-916.

Lim PO, Young WF, MacDonald TM. A review of the medical treatment of primary aldosteronism. J Hypertens. 2001;19(3):353-61.

Crane MG, Harris JJ. Effect of spironolactone in hypertensive patients. Am J Med Sci. 1970;260(6):311-30.

Brown JJ, Davies DL, Ferriss JB. Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin. Br Med J. 1972;2(5816):729-34.

Karagiannis A, Tziomalos K, Papageorgiou A. Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism. Expert Opinion Pharmacotherapy. 2008;9(4):509-15.

Jeunemaitre X, Chatellier G, Kreft-Jais C. Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol. 1987;60(10):820-5.

Tam TS, Wu MH, Masson SC. Eplerenone for hypertension. Cochrane Database Systemat Rev. 2017;2(2):Cd008996.

Parthasarathy HK, Ménard J, White WB. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens. 2011;29(5):980-90.

Hundemer GL, Vaidya A. Primary Aldosteronism Diagnosis and Management: A Clinical Approach. Endocrinol Metabolism Clinics North Am. 2019;48(4):681-700.

Hundemer GL. Primary Aldosteronism: Cardiovascular Outcomes Pre- and Post-treatment. Curr Cardiol Rep. 2019;21(9):93.

Son PT, Reda A, Viet DC. Exchange transfusion in the management of critical pertussis in young infants: a case series. Vox Sang. 2021.

Dluhy RG, Lifton RP. Glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metabol. 1999;84(12):4341-4.

Hirsch AT, Haskal ZJ, Hertzer NR. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):463-654.

Nally JV, Olin JW, Lammert GK. Advances in noninvasive screening for renovascular disease. Cleveland Clin J Med. 1994;61(5):328-36.

Edwards MS, Corriere MA. Contemporary management of atherosclerotic renovascular disease. J Vasc Surg. 2009;50(5):1197-210.