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Exp Clin Endocrinol Diabetes 2016; 124(06): 335-341
DOI: 10.1055/s-0042-105278
Invited review
© Georg Thieme Verlag KG Stuttgart · New York

Recent Developments in Primary Aldosteronism

E. Asbach
1   Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München
,
T. A. Williams
1   Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München
,
M. Reincke
1   Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

received 04 January 2016
first decision 04 January 2016

accepted 08 March 2016

Publication Date:
24 May 2016 (online)

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Abstract

Primary aldosteronism (PA) is the most frequent endocrine cause of secondary arterial hypertension. Sporadic forms of PA caused mainly by an aldosterone producing adenoma (APA) or idiopathic adrenal hyperplasia (IAH) predominate; in contrast, familial forms (familial hyperaldosteronism types I, II and III) affect only a minor proportion of PA patients. Patient based registries and biobanks, international networks and next generation sequencing technologies have emerged over recent years. Somatic hot-spot mutations in the potassium channel GIRK4 (encoded by KCNJ5), in ATPases and a L-type voltage-gated calcium-channel correlate with the autonomous aldosterone production in approximately half of all APAs. The recently discovered form FH III is caused by different germline KCNJ5 mutations with variable clinical presentations and severity. Autoantibodies to the angiotensin II Type 1 receptor have been identified in patients with PA and possibly play a pathophysiological role in the development of PA. Adrenal vein sampling (AVS) represents the gold standard in differentiating unilateral and bilateral forms of PA. Recent consensus papers have tried to implement current guidelines in order to standardise the technique of AVS. New techniques like segmental AVS might allow a finer mapping of the aldosterone production within the adrenal gland. The measurement of the steroids 18-hydroxycortisol and 18-oxocortisol by liquid chromatography tandem mass spectrometry has been shown to be useful to distinguish between unilateral and bilateral forms of PA.

Key words

primary aldosteronism - aldosterone - somatic mutation - KCNJ5 - familial hyperaldosteronism - adrenal vein sampling

Next part of this series:

Hypertension and Diabetic NephropathyExp Clin Endocrinol Diabetes 2016; 124(06): 333-334
DOI: 10.1055/s-0042-110231

 

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