primary hyperaldosteronism (Conn's syndrome)

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Etiology

Epidemiology

Pathology

Genetics

  • family history

Clinical manifestations

* diastolic hypertension without edema

Laboratory

  > 23 ng/dL / ng/mL/hr (positive)[4]
  > 23 ng/dL / ng/mL/hr sensitivity of 97%, specificity of 94%
  > 67 ng/dL / ng/mL/hr sensitivity of 100%
         ^        ^
         |        |
   aldosterone  renin -> angiotensin-1

* plasma levels of aldosterone variable

* 38% of patients with at least 1 level < 15 ng/dL, 14% with at least 1 level < 10 ng/dL[9]

Diagnostic procedures

Radiology

* after laboratory confirmation of autonomous hyperaldosteronism

Complications

Management

More general terms

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 1995
  2. 2.0 2.1 2.2 Douma S et al Prevalence of primary hyperaldosteronism in resistant hypertension: A retrospective observational study. Lancet 2008 Jun 7; 371:1921 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/18539224 <Internet> http://dx.doi.org/10.1016/S0140-6736(08)60834-X
  3. Funder JW et al Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008 Sep;93(9):3266-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18552288
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. Rossi GP, Bernini G, Caliumi C et al A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17161262
  6. Rossi GP, Auchus RJ, Brown M An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014 Jan;63(1):151-60. Epub 2013 Nov 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24218436
  7. 7.0 7.1 Brown JM, Siddiqui M, Calhoun DA et al. The unrecognized prevalence of primary aldosteronism: A cross-sectional study. Ann Intern Med 2020 May 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32449886 https://www.acpjournals.org/doi/10.7326/M20-0065
    Funder JW. Primary aldosteronism: At the tipping point. Ann Intern Med 2020 May 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32449882 https://www.acpjournals.org/doi/10.7326/M20-1758
  8. 8.0 8.1 Cohen JB, Cohen DL, Herman DS et al. Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.S. veterans: A retrospective cohort study. Ann Intern Med 2020 Dec 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33370170 https://www.acpjournals.org/doi/10.7326/M20-4873
  9. 9.0 9.1 Maciel AAW et al. Intra-individual variability of serum aldosterone and implications for primary aldosteronism screening. J Clin Endocrinol Metab 2023 May; 108:1143 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36413507 https://academic.oup.com/jcem/article-abstract/108/5/1143/6840305
  10. Dogra P, Bancos I, Young WF Jr Primary Aldosteronism: A Pragmatic Approach to Diagnosis and Management. Mayo Clinic Proceedings. 2023. 98(8):P1207-1215. August https://www.mayoclinicproceedings.org/article/S0025-6196(23)00239-2/fulltext
  11. 11.0 11.1 11.2 Cohen DL et al. Primary aldosteronism in chronic kidney disease: Blood pressure control and kidney and cardiovascular outcomes after surgical versus medical management. Hypertension 2023 Oct; 80:2187. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37593884 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.21474
  12. 12.0 12.1 NEJM Knowledge+

Patient information

primary hyperaldosteronism (Conn's syndrome) patient information