Browsing by Author "Uslar Nawrath, Thomas Hermann"

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    Discriminative Capacity of CT Volumetry to Identify Autonomous Cortisol Secretion in Incidental Adrenal Adenomas
    (ENDOCRINE SOC, 2022) Olmos Borzone, Roberto Ignacio; Mertens Folch, Nicolas Andres; Vaidya, Anand; Uslar Nawrath, Thomas Hermann; Fernández Walker, Paula Soledad; Guarda Vega, Francisco; Zuñiga, Alvaro; San Francisco Reyes, Ignacio Felipe; Huete Garin, Isidro Alvaro; Baudrand Biggs, Rene Felipe
    Context: Incidentally discovered adrenal adenomas are common. Assessment for possible autonomous cortisol excess (ACS) is warranted for all adrenal adenomas, given the association with increased cardiometabolic disease.
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    The Spectrum from Overt Primary Aldosteronism to Mild Dysregulated Aldosterone Production in Incidentally Discovered Adrenocortical Adenomas
    (2024) Uslar Nawrath, Thomas Hermann; Olmos, Roberto; Burnier, Alberth; Sanfuentes, Benjamín; Böhm, Pauline; Orellana, Maria Paz; Guarda, Francisco J.; Huete, Alvaro; Mertens, Nicolás; Besa, Cecilia; Andia, Marcelo E.; Majerson, Alejandro; Cartes, Jaime; Fardella, Carlos; Allende, Fidel; Solari, Sandra; Vaidya, Anand; Baudrand Biggs, René
    Background Incidental adrenocortical adenomas (IA) are common. Current guidelines suggest screening for primary aldosteronism (PA) only in cases of hypertension or hypokalemia. This study aimed to evaluate the spectrum from overt PA to mild dysregulated aldosterone production with a sensitive protocol irrespective of blood pressure (BP) and potassium in patients with IA.Methods 254 consecutive patients (excluding hypercortisolism) were evaluated. The spectrum of PA was defined as a suppressed renin plus the following criteria: 1)Overt PA: aldosterone-to-renin-ratio (ARR) >30 ng/dL-to-ng/mL/hr, plasma aldosterone concentration (PAC) >15ng/dL, and/or 24h urinary aldosterone >10 ug/24h; 2)Moderate PA: ARR 20-30 ng/dL-to-ng/mL/hr, PAC 10-15 ng/dL; 3)Mild dysregulated aldosterone production: ARR <20 ng/dL-to-ng/mL/hr and PAC >5-10 ng/dL.Results 35% (n=89/254) met criteria for PA spectrum, 20% (34/89) were initially normotensive and 94% (84/89) normokalemic. Overt, moderate, and mild groups were 10%, 12%, and 13%. There were trends across groups of clinical severity: systolic BP (153±19, 140±14, 137±14 mmHg, p-trend<0.05), resistant hypertension (50%, 23%, 7% p-trend=<0.001), daily defined dose of antihypertensives (DDD) (3.2±1.6, 1.2±1.5, 0.4±0.6 p-trend=0.001), and lower eGFR (75.5±30.8, 97.8±38.5, 101±25.5, p-trend<0.01). At follow-up (mean 28±15 months), 87% had treatment with MR antagonists or surgery with decreased systolic BP relative to clinical severity, −31.3 ±23, −12.7 ±19, and −11.4 ±19 mmHg, (p-trend<0.001). Similar trends were observed for DDD, with significant increase in renin.Conclusions There is a prevalent spectrum of clinically-relevant PA and dysregulated aldosterone production in IA, irrespective of BP or potassium, usually undetected. Aldosterone-directed treatment improved BP and normalized renin even in milder cases.