The Spectrum from Overt Primary Aldosteronism to Mild Dysregulated Aldosterone Production in Incidentally Discovered Adrenocortical Adenomas

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dc.catalogadorgrr
dc.contributor.authorUslar Nawrath, Thomas Hermann
dc.contributor.authorOlmos, Roberto
dc.contributor.authorBurnier, Alberth
dc.contributor.authorSanfuentes, Benjamín
dc.contributor.authorBöhm, Pauline
dc.contributor.authorOrellana, Maria Paz
dc.contributor.authorGuarda, Francisco J.
dc.contributor.authorHuete, Alvaro
dc.contributor.authorMertens, Nicolás
dc.contributor.authorBesa, Cecilia
dc.contributor.authorAndia, Marcelo E.
dc.contributor.authorMajerson, Alejandro
dc.contributor.authorCartes, Jaime
dc.contributor.authorFardella, Carlos
dc.contributor.authorAllende, Fidel
dc.contributor.authorSolari, Sandra
dc.contributor.authorVaidya, Anand
dc.contributor.authorBaudrand Biggs, René
dc.date.accessioned2024-04-16T15:39:24Z
dc.date.available2024-04-16T15:39:24Z
dc.date.issued2024
dc.description.abstractBackground 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.
dc.fechaingreso.objetodigital2024-05-16
dc.format.extent25 páginas
dc.fuente.origenORCID
dc.identifier.doi10.1101/2024.04.10.24305640
dc.identifier.urihttps://doi.org/10.1101/2024.04.10.24305640
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/85136
dc.information.autorucEscuela de Medicina; Uslar Nawrath, Thomas Hermann; /0000-0001-7213-855X; 187161
dc.information.autorucEscuela de Medicina; Baudrand Biggs, René ; 0000-0002-8655-4957; 1024
dc.language.isoen
dc.nota.accesocontenido completo
dc.rightsacceso abierto
dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.en
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleThe Spectrum from Overt Primary Aldosteronism to Mild Dysregulated Aldosterone Production in Incidentally Discovered Adrenocortical Adenomas
dc.typepreprint
sipa.codpersvinculados187161
sipa.codpersvinculados1024
sipa.trazabilidadORCID;2024-04-15
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