The Spectrum of Dysregulated Aldosterone Production: An International Human Physiology Study
Authors' conclusion
In the context of a low-renin phenotype, there is a continuum of primary aldosteronism and dysregulated aldosterone production that is prominently influenced by ACTH. A large proportion of individuals with low renin may benefit from aldosterone-directed therapy.
Study context
- Population
- Individuals with a low-renin phenotype across the BP continuum (severe/resistant hypertension, hypertension with hypokalemia, elevated BP and stage I/II hypertension, normal BP); 4 international centerslow-renin phenotype
- Participants
- 348 individuals
- Comparison
- Severe and/or resistant hypertension vs Hypertension with hypokalemia vs elevated blood pressure and stage I/II hypertension vs normal blood pressure
- Outcome
- Magnitude of renin-independent aldosteronism (SST), ACTH-mediated aldosteronism (dexamethasone suppression and ACTH-stimulation tests), and lateralization (adrenal venous sampling)
Methodological detailshuman physiology study, multicentre (4 international centers)
- Human physiology study
- Multicentre (4 international centers)
Main finding
As reported in the abstract
Correlation of post-SST aldosterone with ACTH-stimulated aldosterone production
r = 0.75
P < .0001
Correlation of post-SST aldosterone with nonsuppressible aldosterone postdexamethasone
r = 0.40
P < .0001
Further findings
Lateralizing aldosteronism below PA diagnostic threshold (post-SST aldosterone <10 ng/dL or <277 pmol/L)
- Lateralizing aldosteronism amenable to surgical adrenalectomy
- 15%
- Remainder treated with mineralocorticoid receptor antagonists
Original publication
The Spectrum of Dysregulated Aldosterone Production: An International Human Physiology Study. J Clin Endocrinol Metab. Published 7 March 2024. doi:10.
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