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Horm Metab Res 2017; 49(11): 838-846
DOI: 10.1055/s-0043-118909
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Clinical Characteristics and Long-Term Outcome of Primary Aldosteronism in a Norwegian Population

Marianne Aardal Grytaas
1   Department of Clinical Science, University of Bergen, Bergen, Norway
2   Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
,
Siri S. Strømsøy
3   Department of Molecular Biology, University of Bergen, Bergen, Norway
,
Jarle Tor Rørvik
4   Department of Clinical Medicine, University of Bergen, Bergen, Norway
5   Department of Radiology, Haukeland University Hospital, Bergen, Norway
,
Jarle Birger Arnes
6   Department of Pathology, Haukeland University Hospital, Bergen, Norway
,
Anette Heie
7   Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
,
Thomas Arnesen
3   Department of Molecular Biology, University of Bergen, Bergen, Norway
7   Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
,
Melissa D. Jørstad
8   The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
,
Bjørn Gunnar Nedrebø
1   Department of Clinical Science, University of Bergen, Bergen, Norway
9   Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway
,
Dag Erik Jøssang
5   Department of Radiology, Haukeland University Hospital, Bergen, Norway
,
Dag Kjartan Jensen
5   Department of Radiology, Haukeland University Hospital, Bergen, Norway
,
Håvard D. Rørvik
4   Department of Clinical Medicine, University of Bergen, Bergen, Norway
,
Jørn Vegard Sagen
1   Department of Clinical Science, University of Bergen, Bergen, Norway
8   The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
,
Gunnar Mellgren
1   Department of Clinical Science, University of Bergen, Bergen, Norway
8   The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
,
Hrafnkell B. Thordarson
1   Department of Clinical Science, University of Bergen, Bergen, Norway
2   Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
,
Eystein Sverre Husebye
1   Department of Clinical Science, University of Bergen, Bergen, Norway
2   Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
,
Kristian Løvås
1   Department of Clinical Science, University of Bergen, Bergen, Norway
2   Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
› Author Affiliations
Further Information

Publication History

received 05 April 2017

accepted 23 August 2017

Publication Date:
18 September 2017 (online)

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Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension (HT). We describe here clinical characteristics, diagnostic procedures, and long-term outcomes in a Norwegian population. All suspected PA patients investigated at a tertiary centre from 1998–2012 were retrospectively evaluated. Inclusion criteria were verified PA after confirmatory testing or otherwise considered highly likely PA. Clinical, biochemical, radiological, and adrenal vein sampling (AVS) findings were analysed. Surgically removed adrenals were re-evaluated histopathologically and tested for somatic mutations. All patients still alive by August 2014 were invited to a follow-up visit. One-hundred and eight patients were included, of whom 85% had a history of hypokalaemia. PA was verified by confirmatory testing in 83 (77%), and AVS performed in 95 (88%) patients. The proportion with AVS-confirmed bilateral PA increased during the study period. Sixty-eight patients (63%) underwent adrenalectomy. KCNJ5 mutations were found in 30% of the surgical specimens and were associated with female sex and a florid PA phenotype. Follow-up visits were undertaken in 73/108 (68%), of whom 52 adrenalectomised. After adrenalectomy, 83% were biochemically cured of PA, but only 21% were cured for HT. Female sex, a verified adenoma, and KCNJ5 mutations were associated with cure of HT. In conclusion, the majority of our patients had unilateral PA and hypokalaemia, indicating that patients with bilateral and milder PA may still be underdiagnosed. Female sex, a histopathological adenoma, and the presence of KCNJ5 mutations predicted cure of HT after adrenalectomy, but the overall cure rate of HT was low.

Key words

primary aldosteronism - KCNJ5 - adrenal venous sampling - adrenalectomy

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