Primary hyperaldosteronism historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Primary hyperaldosteronism (Conn's syndrome) was described for the first time by the Polish internist, Michał Lityński. In 1955, Dr Jerome W. Conn, the American endocrinologist, first described the condition and named it Conn's syndrome. Over the last few decades other more rare type of primary hyperaldosteronism have also been described. From 1960s to early 1970s, techniques of diagnosis and treatment were greatly improved by the availability of spironolactone, realization of the renin-angiotensin-aldosterone system, and progress in laboratory tests and adrenal venous sampling.
Historical Perspective
- Primary hyperaldosteronism (Conn's syndrome) was described for the first time by the Polish internist, Michał Lityński.[1]
- In 1955, Dr Jerome W. Conn, the American endocrinologist, first described the condition and named it Conn's syndrome.[2][3]
- By 1964, Conn had collected 145 cases, and he postulated that up to 20% of patients with essential hypertension might have primary aldosteronism and later stated that the actual prevalence may be less than he previously thought. He predicted prevalence of primary aldosteronism to be 10% of hypertensives patients, a prediction that became true nearly 40 years later.[4]
- From 1960s to early 1970s, techniques of diagnosis and treatment were greatly improved by the availability of spironolactone, realization of the renin-angiotensin-aldosterone system, and progress in laboratory tests and adrenal venous sampling.
- On October 19, 1964, Jerome W. Conn, Edwin L. Cohen, and David R. Rovner differentiated between primary and secondary aldosteronism in hypertensive disease.[5]
- In 1970s, there was an extensive application of modern imaging modalities, such as CT scanning, adrenal venous sampling and steroid analysis.[6]
- From 1980s, more and more patients with primary aldosteronism were screened out from the hypertensive population by plasma renin activity/plasma aldosterone concentration ratio and cured by surgical interventions; laparoscopic unilateral adrenalectomy has become the generally accepted gold standard of operation.[7]
- In the subsequent decades, besides aldosterone-producing adenoma (APA) described by Conn, six other subtypes of primary aldosteronism have been described. APA and bilateral idiopathic hyperaldosteronism (IHA) are the most common subtypes of primary aldosteronism. Other types that were discovered are unilateral hyperplasia or primary adrenal hyperplasia (PAH).[8]
- Familial hyperaldosteronism (FH) is also rare and three types of that have been described.[9]
References
- ↑ Kucharz EJ (2007). "[Michał Lityński--a forgotten author of the first description on primary hyperaldosteronism]". Pol. Arch. Med. Wewn. (in Polish). 117 (1–2): 57–8. PMID 17642209.
- ↑ Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians 1955;68:215-31; discussion, 231-3. PMID 13299331.
- ↑ "Grand Rounds: Primary Aldosteronism, Beyond Conn's Syndrome | Clinical Correlations".
- ↑ CONN JW, KNOPF RF, NESBIT RM (1964). "CLINICAL CHARACTERISTICS OF PRIMARY ALDOSTERONISM FROM AN ANALYSIS OF 145 CASES". Am. J. Surg. 107: 159–72. PMID 14099489.
- ↑ Conn JW, Cohen EL, Rovner DR (1985). "Landmark article Oct 19, 1964: Suppression of plasma renin activity in primary aldosteronism. Distinguishing primary from secondary aldosteronism in hypertensive disease. By Jerome W. Conn, Edwin L. Cohen and David R. Rovner". JAMA. 253 (4): 558–66. PMID 3881606.
- ↑ Lingam RK, Sohaib SA, Vlahos I, Rockall AG, Isidori AM, Monson JP, Grossman A, Reznek RH (2003). "CT of primary hyperaldosteronism (Conn's syndrome): the value of measuring the adrenal gland". AJR Am J Roentgenol. 181 (3): 843–9. doi:10.2214/ajr.181.3.1810843. PMID 12933492.
- ↑ Rayner BL, Opie LH, Davidson JS (2000). "The aldosterone/renin ratio as a screening test for primary aldosteronism". S. Afr. Med. J. 90 (4): 394–400. PMID 10957926.
- ↑ "Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism".
- ↑ Quack I, Vonend O, Rump LC (2010). "Familial hyperaldosteronism I-III". Horm. Metab. Res. 42 (6): 424–8. doi:10.1055/s-0029-1246187. PMID 20131203.