Primary hyperaldosteronism natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 10: Line 10:


==Complications==
==Complications==
Primary aldosteronism is characterized by the development of the following complications:<ref name="pmid10023636">{{cite journal |vauthors=Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G |title=Cardiovascular complications in patients with primary aldosteronism |journal=Am. J. Kidney Dis. |volume=33 |issue=2 |pages=261–6 |year=1999 |pmid=10023636 |doi= |url= |issn=}}</ref><ref name="pmid19356005">{{cite journal |vauthors=Giacchetti G, Turchi F, Boscaro M, Ronconi V |title=Management of primary aldosteronism: its complications and their outcomes after treatment |journal=Curr Vasc Pharmacol |volume=7 |issue=2 |pages=244–49 |year=2009 |pmid=19356005 |doi= |url= |issn=}}</ref><ref name="pmid20119885">{{cite journal |vauthors=Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S |title=Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry |journal=Horm. Metab. Res. |volume=42 |issue=6 |pages=435–9 |year=2010 |pmid=20119885 |doi=10.1055/s-0029-1246189 |url= |issn=}}</ref><ref name="pmid26311088">{{cite journal |vauthors=Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A |title=Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry |journal=Eur. J. Endocrinol. |volume=173 |issue=5 |pages=665–75 |year=2015 |pmid=26311088 |doi=10.1530/EJE-15-0450 |url= |issn=}}</ref>
Primary aldosteronism is characterized by the development of the following complications:<ref name="pmid10023636">{{cite journal |vauthors=Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G |title=Cardiovascular complications in patients with primary aldosteronism |journal=Am. J. Kidney Dis. |volume=33 |issue=2 |pages=261–6 |year=1999 |pmid=10023636 |doi= |url= |issn=}}</ref><ref name="pmid19356005">{{cite journal |vauthors=Giacchetti G, Turchi F, Boscaro M, Ronconi V |title=Management of primary aldosteronism: its complications and their outcomes after treatment |journal=Curr Vasc Pharmacol |volume=7 |issue=2 |pages=244–49 |year=2009 |pmid=19356005 |doi= |url= |issn=}}</ref><ref name="pmid20119885">{{cite journal |vauthors=Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S |title=Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry |journal=Horm. Metab. Res. |volume=42 |issue=6 |pages=435–9 |year=2010 |pmid=20119885 |doi=10.1055/s-0029-1246189 |url= |issn=}}</ref><ref name="pmid26311088">{{cite journal |vauthors=Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A |title=Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry |journal=Eur. J. Endocrinol. |volume=173 |issue=5 |pages=665–75 |year=2015 |pmid=26311088 |doi=10.1530/EJE-15-0450 |url= |issn=}}</ref><ref name="pmid9221268">{{cite journal |vauthors=Gordon RD |title=Primary aldosteronism |journal=J. Endocrinol. Invest. |volume=18 |issue=7 |pages=495–511 |year=1995 |pmid=9221268 |doi=10.1007/BF03349761 |url= |issn=}}</ref><ref name="urlPrevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://academic.oup.com/jcem/article/91/2/454/2843303/Prevalence-and-Characteristics-of-the-Metabolic |title=Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism &#124; The Journal of Clinical Endocrinology & Metabolism &#124; Oxford Academic |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>


'''Cardiovascular complications'''
'''Cardiovascular complications'''
Line 17: Line 17:
*Atrial fibrillation
*Atrial fibrillation
'''Neurological complications'''
'''Neurological complications'''
*Stroke
*Stroke<ref name="pmid9221268">{{cite journal |vauthors=Gordon RD |title=Primary aldosteronism |journal=J. Endocrinol. Invest. |volume=18 |issue=7 |pages=495–511 |year=1995 |pmid=9221268 |doi=10.1007/BF03349761 |url= |issn=}}</ref>
*Hypertensive encephelopathy
*Hypertensive encephelopathy
'''Renal complications'''
'''Renal complications'''
*Proteinuria including microalbuminuria
*Proteinuria including microalbuminuria<ref name="pmid21738054">{{cite journal |vauthors=Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW, Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai TJ, Ho YL, Lin SL, Wang WJ, Wu KD |title=Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment |journal=J. Hypertens. |volume=29 |issue=9 |pages=1778–86 |year=2011 |pmid=21738054 |doi=10.1097/HJH.0b013e3283495cbb |url= |issn=}}</ref>
*Renal cysts
*Renal cysts<ref name="pmid17563567">{{cite journal |vauthors=Novello M, Catena C, Nadalini E, Colussi GL, Baroselli S, Chiuch A, Lapenna R, Bazzocchi M, Sechi LA |title=Renal cysts and hypokalemia in primary aldosteronism: results of long-term follow-up after treatment |journal=J. Hypertens. |volume=25 |issue=7 |pages=1443–50 |year=2007 |pmid=17563567 |doi=10.1097/HJH.0b013e328126855b |url= |issn=}}</ref>
'''Metabolic complications'''
'''Metabolic complications'''
*Metabolic syndrome
*Metabolic syndrome<ref name="pmid17442220">{{cite journal |vauthors=Fallo F, Federspil G, Veglio F, Mulatero P |title=The metabolic syndrome in primary aldosteronism |journal=Curr. Hypertens. Rep. |volume=9 |issue=2 |pages=106–11 |year=2007 |pmid=17442220 |doi= |url= |issn=}}</ref><ref name="urlMetabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect">{{cite web |url=http://www.sciencedirect.com/science/article/pii/S0939475309000635 |title=Metabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
*Diabetes mellitus
*Diabetes mellitus<ref name="pmid20119885">{{cite journal |vauthors=Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S |title=Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry |journal=Horm. Metab. Res. |volume=42 |issue=6 |pages=435–9 |year=2010 |pmid=20119885 |doi=10.1055/s-0029-1246189 |url= |issn=}}</ref><ref name="urlPrevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://academic.oup.com/jcem/article/91/2/454/2843303/Prevalence-and-Characteristics-of-the-Metabolic |title=Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism &#124; The Journal of Clinical Endocrinology & Metabolism &#124; Oxford Academic |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
==Prognosis==
==Prognosis==
*The prognosis of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant hypertension-related complications, which may be a major cause of morbidity and mortality among patients.
*The prognosis of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant hypertension-related complications, which may be a major cause of morbidity and mortality among patients.

Revision as of 20:05, 18 July 2017

Primary hyperaldosteronism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Primary Hyperaldosteronism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

CT scan Findings

MRI Findings

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Primary hyperaldosteronism natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Primary hyperaldosteronism natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Primary hyperaldosteronism natural history, complications and prognosis

CDC on Primary hyperaldosteronism natural history, complications and prognosis

Primary hyperaldosteronism natural history, complications and prognosis in the news

Blogs on Primary hyperaldosteronism natural history, complications and prognosis

Directions to Hospitals Treating Conn syndrome

Risk calculators and risk factors for Primary hyperaldosteronism natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

If left untreated, patients with primary hyperaldosteronism may progress to develop stroke, coronary artery disease, and renal insufficiency with associated proteinuria. APAs continue to grow slowly over time. The aldosterone production likely correlates with the size of the adenoma. Primary hyperladosteronism can be progressive leading to increased severity of disease. Common complications of primary hyperaldosteronism include left ventricular hypertrophy due to chronic hypertension, atrial fibrillation, myocardial infarction, stroke, proteinuria and metabolic syndrome.

Natural History

  • The natural history of primary hyperaldosteronism other than familial hyperaldosteronism type I (FH-I) is for progressive increase in disease severity, ebentually leading to involvement of both adrenals.[1]
  • If left untreated, patients with primary hyperaldosteronism may progress to develop severe resistant hypertension leading to stroke, coronary artery disease, and renal insufficiency with associated proteinuria.[2]

Complications

Primary aldosteronism is characterized by the development of the following complications:[3][4][5][6][7][8]

Cardiovascular complications

  • Left ventricular hypertrophy
  • Myocardial infarction
  • Atrial fibrillation

Neurological complications

  • Stroke[7]
  • Hypertensive encephelopathy

Renal complications

  • Proteinuria including microalbuminuria[9]
  • Renal cysts[10]

Metabolic complications

Prognosis

  • The prognosis of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant hypertension-related complications, which may be a major cause of morbidity and mortality among patients.
  • Adrenalectomy lowers long-term all-cause mortality from primary hyperaldosteronism.[13][14][15]

Patients undergoing unilateral adrenalectomy for unilateral adenoma

  • Adrenalectomy leads to cure of HTN in 50% to 60% of patients.[16][17]
  • Blood pressure typically becomes normal after 1 to 6 months of the procedure.[18]
  • Treatment leads to a significant increase in quality of life and improved cardiovascular outcomes.

Patients receiving aldosterone antagonist medications

  • Hypertension is controlled in majority of the patients.[16][17]
  • Improvements are not as significant as after unilateral adrenalectomy for lateralizing lesions.

Patients with FH-I undergoing treatment with glucocorticoid medications

  • Hypertension in familial hyperaldosteronism type I (FH-I) is usually of early onset and may be severe enough to cause early death, usually from hemorrhagic stroke, unless specifically treated.[19]
  • Treatment with glucocorticoids, given in low doses is usually effective in controlling hypertension and consequently preventing stroke.

References

  1. ↑ Gordon RD (1997). "Primary aldosteronism: a new understanding". Clin. Exp. Hypertens. 19 (5–6): 857–70. PMID 9247760.
  2. ↑ "Cardiovascular complications in patients with primary aldosteronism - ScienceDirect".
  3. ↑ Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G (1999). "Cardiovascular complications in patients with primary aldosteronism". Am. J. Kidney Dis. 33 (2): 261–6. PMID 10023636.
  4. ↑ Giacchetti G, Turchi F, Boscaro M, Ronconi V (2009). "Management of primary aldosteronism: its complications and their outcomes after treatment". Curr Vasc Pharmacol. 7 (2): 244–49. PMID 19356005.
  5. ↑ 5.0 5.1 Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S (2010). "Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry". Horm. Metab. Res. 42 (6): 435–9. doi:10.1055/s-0029-1246189. PMID 20119885.
  6. ↑ Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A (2015). "Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry". Eur. J. Endocrinol. 173 (5): 665–75. doi:10.1530/EJE-15-0450. PMID 26311088.
  7. ↑ 7.0 7.1 Gordon RD (1995). "Primary aldosteronism". J. Endocrinol. Invest. 18 (7): 495–511. doi:10.1007/BF03349761. PMID 9221268.
  8. ↑ 8.0 8.1 "Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".
  9. ↑ Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW, Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai TJ, Ho YL, Lin SL, Wang WJ, Wu KD (2011). "Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment". J. Hypertens. 29 (9): 1778–86. doi:10.1097/HJH.0b013e3283495cbb. PMID 21738054.
  10. ↑ Novello M, Catena C, Nadalini E, Colussi GL, Baroselli S, Chiuch A, Lapenna R, Bazzocchi M, Sechi LA (2007). "Renal cysts and hypokalemia in primary aldosteronism: results of long-term follow-up after treatment". J. Hypertens. 25 (7): 1443–50. doi:10.1097/HJH.0b013e328126855b. PMID 17563567.
  11. ↑ Fallo F, Federspil G, Veglio F, Mulatero P (2007). "The metabolic syndrome in primary aldosteronism". Curr. Hypertens. Rep. 9 (2): 106–11. PMID 17442220.
  12. ↑ "Metabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect".
  13. ↑ "Long term outcome of Aldosteronism after target treatments | Scientific Reports".
  14. ↑ "Treatment strategy and outcome with primary aldosteronism: a nationwide longitudinal cohort based study".
  15. ↑ Celen O, O'Brien MJ, Melby JC, Beazley RM (1996). "Factors influencing outcome of surgery for primary aldosteronism". Arch Surg. 131 (6): 646–50. PMID 8645073.
  16. ↑ 16.0 16.1 Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM (2003). "High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients". J. Hypertens. 21 (11): 2149–57. doi:10.1097/01.hjh.0000098141.70956.53. PMID 14597859.
  17. ↑ 17.0 17.1 Stowasser M, Gordon RD (2004). "Primary aldosteronism--careful investigation is essential and rewarding". Mol. Cell. Endocrinol. 217 (1–2): 33–9. doi:10.1016/j.mce.2003.10.006. PMID 15134798.
  18. ↑ Stowasser M, Gordon RD, Rutherford JC, Nikwan NZ, Daunt N, Slater GJ (2001). "Diagnosis and management of primary aldosteronism". J Renin Angiotensin Aldosterone Syst. 2 (3): 156–69. doi:10.3317/jraas.2001.022. PMID 11881117.
  19. ↑ Stowasser M, Gartside MG, Gordon RD (1997). "A PCR-based method of screening individuals of all ages, from neonates to the elderly, for familial hyperaldosteronism type I". Aust N Z J Med. 27 (6): 685–90. PMID 9483237.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Primary_hyperaldosteronism_natural_history,_complications_and_prognosis&oldid=1327003"