Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

J Clin Hypertens (Greenwich). 2018 May;20(5):942-948. doi: 10.1111/jch.13291. Epub 2018 May 2.

Abstract

Primary aldosteronism (PA) is a common form of secondary hypertension. Several guidelines recommend that patients with adrenal incidentaloma have a high probability of suffering from PA. We conducted a prospective study of 269 consecutive adults with adrenal incidentaloma to investigate the prevalence and clinical characteristics of PA. In total, 9 participants were detected with PA, suggesting a prevalence of 3.35% among the study population. PA participants had a higher blood pressure level by 14/20.8 mm Hg and a lower serum potassium level by 0.8 mmol/L (P < .05). Importantly, all patients with PA presented with concurrent indications (hypertension with or without hypokalemia) for screening of the disease, but they have not undergone relative screening by the referring physician, thus casting doubts about the appropriate implementation of current guidelines in real-life practice. Intense efforts are needed to familiarize physicians with recommendations for PA to minimize undiagnosed cases and the detrimental sequelae of this endocrine form of hypertension.

Keywords: adrenal incidentaloma; hypertension; hypokalemia; primary aldosteronism; resistant hypertension.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adrenal Gland Neoplasms / epidemiology
  • Adrenal Gland Neoplasms / etiology*
  • Aged
  • Aldosterone / blood
  • Female
  • Humans
  • Hyperaldosteronism / diagnosis*
  • Hyperaldosteronism / epidemiology
  • Hypertension / epidemiology
  • Hypertension / etiology*
  • Hypokalemia / diagnosis*
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Practice Guidelines as Topic
  • Prevalence
  • Prospective Studies
  • Renin / blood

Substances

  • Aldosterone
  • Renin

Supplementary concepts

  • Adrenal incidentaloma