Systematic hormonal screening of incidentally discovered adrenal tumors yields a high detection of hyperaldosteronism

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dc.catalogadorvzp
dc.contributor.authorS. Macchiavello
dc.contributor.authorR. Olmos
dc.contributor.authorF. Guarda
dc.contributor.authorJ. Gutiérrez
dc.contributor.authorI. San Francisco
dc.contributor.authorA. Zúñiga
dc.contributor.authorA. Huete
dc.contributor.authorG. Mendez
dc.contributor.authorR. Baudrand
dc.date.accessioned2024-05-31T13:40:24Z
dc.date.available2024-05-31T13:40:24Z
dc.date.issued2019
dc.description.abstractObjective: The detection of adrenal incidentalomas is increasing. Current European guidelines suggest that all adrenal incidentalomas (AI) should be screened for excess cortisol and cathecolamines, but excess aldosterone only in the presence of hypertension and/or hypokalemia. Consistently, the reported prevalence of primary aldosteronism (PA), in AI is only 2–6%. The spectrum of primary aldosteronism has expanded to patients with mild hypertension and normokalemia, or even normotensives. Interestingly, even so-called “non-functioning” AI have been associated with future risk of hypertension. Screening by hypertensive status and diagnosis based on strict PA criteria suggest that current biochemical study is incomplete and/or insensitive to detect mild cases. To evaluate whether a systematic protocolized study can improve the detection of PA in adrenal incidentalomas. Design and method: We recruited a cohort of 226 adults with an adrenal incidentaloma, evaluated in our endocrinology clinic. We measured in all patients (hypertensives and normotensives) plasma aldosterone and renin with a protocolized approach: measurement in seated position, with unrestricted sodium intake, during follicular phase in premenopausal women and performing washout of confounding medications in selected cases. We defined a positive PA screening with suppressed renin in the setting of plasma aldosterone >6 ng/dL and aldosterone-renin ratio >20. We defined confirmed PA with either a positive confirmatory test or achievement of clinical and biochemical success criteria for PA treatment with adrenal surgery or aldosterone antagonists, as published by PASO study group. Results: Considering all subjects with AI, 17.25% (39/226) had a positive screening for PA and confirmed in 11% (25/226). These subjects had female predominance 68%, mean age 54 years, mean adenoma size 20 mm and did not differ from subjects with AI. Also, among confirmed cases 25% (5/25) were normotensive and 8% (2/25) had hypokalemia. Conclusions: Our study suggests that an important proportion of patients with PA are not currently being detected by usual clinical care of adrenal incidentalomas. Our protocolized study, including normotensive subjects and sensitive thresholds, improves diagnosis of milder cases. Since PA is associated with significant cardiovascular morbidity, earlier detection of the complete spectrum of this disease is clinically relevant.
dc.format.extent1 página
dc.fuente.origenORCID
dc.identifier.doi10.1097/01.hjh.0000573448.50003.27
dc.identifier.eissn1473-5598
dc.identifier.urihttps://doi.org/10.1097/01.hjh.0000573448.50003.27
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/86160
dc.information.autorucEscuela de Medicina; Baudrand Biggs, Rene Felipe; 0000-0002-8655-4957; 1024
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.finalE270
dc.pagina.inicioE270
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.relation.isformatof29th European Meeting of Hypertension and Cardiovascular Protection of the European-Society-of-Hypertension (ESH), JUN 21-24, 2019, Milan, ITALY
dc.revistaJourna of Hypertension
dc.rightsacceso restringido
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleSystematic hormonal screening of incidentally discovered adrenal tumors yields a high detection of hyperaldosteronism
dc.typecomunicación de congreso
dc.volumen37
sipa.codpersvinculados1024
sipa.trazabilidadORCID;2024-05-27
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