Prevalence and main characteristics of primary aldosteronism in bilateral macronodular adrenal disease: a systematic review of the literature
Authors' conclusion
This review highlights the need for increased screening for PA in younger, hypertensive BMAD patients. Larger multicenter studies are needed to determine the association between these conditions, cardiovascular risk, and optimal treatment.
Study context
- Population
- Case reports and series of bilateral macronodular adrenal disease (BMAD) patients with primary aldosteronism (PA); BMAD defined by bilateral adrenal nodules ≥10 mm; PA per US or Japanese Endocrine Society guidelines18 articles
- Participants
- 68 participants
- Comparison
- BMAD with PA vs BMAD with isolated cortisol hypersecretion vs unilateral PA (uPA)
- BMAD with PAn = 66
- Outcome
- Prevalence and characteristics of PA in BMAD
Methodological detailsPRISMA guidelines, comparison with 2 single-centre cohorts (LMU Hospital Munich)
- PRISMA guidelines
- Comparison with 2 single-centre cohorts (LMU Hospital Munich)
Pooled result
As reported in the abstract
Prevalence of PA in published BMAD series
PA proportion in published BMAD series
2% to 43%
Male, BMAD with PA
75%
Further pooled results
| Outcome | BMAD with PA | BMAD with isolated cortisol hypersecretion | uPA | P value |
|---|---|---|---|---|
| AgeBMAD with PA vs BMAD with isolated cortisol hypersecretion · younger with BMAD with PA · median, years | 51.5 | 60.5 | — not stated in the abstract | P < 0.01 |
| Blood pressureBMAD with PA vs BMAD with isolated cortisol hypersecretion | median 170/100 mm Hg | 138/80 mm Hg | 153/94 mm Hg | P < 0.01 |
— not stated in the abstract
- Blood pressure: higher with BMAD with PA; vs isolated cortisol hypersecretion or uPA
Treatment and clinical outcome
- Treatment described
- 28 cases
- Underwent adrenalectomy
- 93%
- Clinical outcome was similar across groups post-treatment
BMAD with aldosterone precursor excess
- Cases with aldosterone precursor excess
- 2
Original publication
Prevalence and main characteristics of primary aldosteronism in bilateral macronodular adrenal disease: a systematic review of the literature. Eur J Endocrinol. Published 18 February 2025. doi:10.
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