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Hypertension corrected by discontinuing chronic sodium bicarbonate ingestion. Subsequent transient hypoaldosteronism.

A 52 year old man with a long history of marked hypertension, peptic ulcer disease, nephrocalcinosis and intermittent hypercalcemia was referred to be evaluated for primary aldosteronism suspected on the basis of low plasma renin activity, hypokalemia and blood pressure responsive to spironolactone. Aldosterone excretion, however, was extremely low. Alkaluria, high urinary sodium excretion and hypercalciuria were observed. The patient admitted to chronic ingestion of large amounts of baking soda. Upon cessation of alkali abuse, his blood pressure fell dramatically; orthostatic hypotension, con

Gout as a complication of Bartter's syndrome. A possible role for alkalosis in the decreased clearance of uric acid.

A prevalence of hyperuricemia of 50% and of acute gouty arthritis of 20% has been observed in a group of patients with Bartter's syndrome. All patients except one presented initially with complaints unrelated to uric acid metabolism. The cause of their hyperuricemia and subnormal clearance of uric acid is unexplained. Systemic alkalosis, a prominent feature of Bartter's syndrome, can decrease the clearance of uric acid and may contribute to the hyperuricemia and gout that have been observed. Physicians should be aware of the possibility of gout as a clinical complication of Bartter's syndrome

Насколько общим является гиперкортизолизм у пациентов с гипертензией? Факторы риска, эпидемиология и диагностика.

Эндогенный гиперкортизолизм (ЭГК) является недооцененным и клинически значительным фактором гипертонии, особенно резистентной гипертонии. После того, как EHC считается редким субъектом, он теперь воспринимается как спектр избытка кортизола, связанного с неблагоприятными кардиометаболическими результатами и ущербом, причиненным мишени. Недавно проведенные широкомасштабные исследования свидетельствуют о значительном увеличении распространенности ЭГК среди пациентов с устойчивой гипертонией и трудноконтролируемым диабетом, зачастую в отсутствие классических особенностей кушингоида. В настоящем об

Совпадение в полном тексте источника
… In MOMENTUM, biochemical markers suggestive of hyperaldosteronism were found in ~20% of the studied population. … Notably, this study shows that the prevalence of hypercortisolism in individuals with resistant hypertension rivals that of hyperaldosteronism, a striking observation, given that hyperaldosteronism has long been regarded as the most common endocrine cause of resistant hypertension. …

Equivalence of the Peripheral Common Trunk and Adrenal Central Vein in Left Adrenal Vein Sampling.

PURPOSE: To compare 3 left adrenal vein sampling (AVS) sites-the left adrenal central vein (LCV), the peripheral common trunk (P-CMT), which is near the confluence of the inferior phrenic vein and LCV, and the middle common trunk (M-CMT)-and attempt to identify the reliable site for left AVS. MATERIALS AND METHODS: Consecutive patients with primary aldosteronism who underwent AVS at a general hospital (September 2019 to October 2023) were enrolled. Procedure details and clinical data were collected to analyze the success rates of blood sampling (selectivity index [SI] ≥ 2), aldosterone-to-cor

Can the size of adrenal tumor impact hormonal secretion? A retrospective analysis of 170 adrenalectomies in a single center.

PURPOSE: Adrenal tumors are a heterogeneous group of neoplasms that may be hormonally active or inactive. Tumor size is a key factor in evaluating and managing these lesions. Understanding how size impacts hormonal activity, surgical outcomes, and complications can help guide treatment and follow-up. This study investigates the relationship between tumor size, hormonal secretion, and clinical outcomes in adrenal tumors. METHODS: We retrospectively analyzed data from patients who underwent adrenalectomy between 2007 and 2023 at the University Hospital of Basel. Tumors were categorized by pathol

Clinical value of multi-time-point 68Ga-Pentixafor PET/CT imaging in the subtype diagnosis of primary aldosteronism.

PURPOSE: This study aimed to determine the suitable imaging time and validate the diagnostic accuracy of 68Ga-Pentixafor PET/CT for subtyping primary aldosteronism (PA). METHODS: This two-part study enrolled patients with PA. Part 1 identified suitable PET/CT time points (0–120 min) using multi-time-point imaging. Part 2 assessed the diagnostic performance in distinguishing unilateral PA (UPA) and bilateral PA (BPA). The diagnostic classification integrated AVS lateralization, imaging (visual analysis and lateralization index [LI] based on SUVmax and SUVpeak), and follow-up. RESULTS: The multi

Diagnostic value of unilateral adrenal vein sampling with simple and biochemical/imaging correction: a study on early screening and typing for primary aldosteronism.

OBJECTIVE: Adrenal vein sampling (AVS) is the gold standard for distinguishing subtypes for primary aldosteronism. However, its technical challenges and frequent intubation failures pose difficulties. Our study aimed to establish diagnostic models for unilateral primary aldosteronism (UPA) to guide appropriate treatment in early patients. METHODS: We retrospectively analyzed 274 consecutive patients undergoing AVS without adrenocorticotropic hormone (ACTH) stimulated. We established a diagnostic model corrected by biochemical/imaging, and evaluated the diagnostic value of adrenal vein aldoste

Prevalence, clinical characteristics and management of low-renin hypertension: a real-world cohort study.

Emerging evidence suggests that patients with low-renin hypertension (LRH) benefit from targeted treatment with mineralocorticoid receptor antagonists (MRA). With broader screening for primary aldosteronism (PA), clinicians are increasingly identifying patients with low renin levels who do not meet current diagnostic criteria for PA. In the absence of specific management guidelines, these patients are often treated as having primary hypertension. This study aimed to assess the prevalence, clinical characteristics, and real-world management of LRH in a tertiary endocrine hypertension clinic. We

Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension.

OBJECTIVE: Primary aldosteronism (PA) is a common cause of hypertension. It entails elevated morbidity and mortality that do not sufficiently improve with conventional antihypertensive therapy. Screening for PA by plasma aldosterone-renin ratio (ARR) enables discovery and specific treatment of affected patients. By screening primary care patients with hypertension and evaluating them further according to the Endocrine Society guidelines, we aimed to assess the prevalence of PA, the factors affecting biochemical diagnostics, and the outcome of lateralization studies and of specific treatment of

The Effectiveness of Metanephrine-Based Compared with Cortisol-Based Measurements to Assess Selectivity and Lateralization of Adrenal Vein Sampling in Primary Aldosteronism: A Systematic Review.

PURPOSE: To evaluate the effectiveness of metanephrine-based compared with cortisol-based measurements in assessing successful adrenal vein (AV) cannulation to determine diagnostic AV sampling (AVS) procedures. MATERIALS AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search was conducted using 3 electronic medical databases-PubMed, Embase, and MEDLINE-from inception to the third week of December 2024. Studies that compared metanephrine-based with cortisol-based measurements in adult patients with biochemically est

Multiparametric diffusion-weighted MRI for renal microstructural assessment in patients with primary aldosteronism at varying direct renin concentrations.

PURPOSE: To utilize multiparametric diffusion-weighted imaging (DWI) to detect and quantify renal microstructural alterations in patients with primary aldosteronism (PA) at varying direct renin concentrations (DRC), and to explore the correlations between DWI-derived biomarkers and renal function biochemical indices. MATERIALS AND METHODS: This study included 50 patients and 32 healthy controls (HCs). Participants underwent 3.0 T MRI using monoexponential, intravoxel incoherent motion, and stretched-exponential DWI models. Two observers independently analyzed diffusion parameters, including a

Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines.

OBJECTIVE: Historical studies report complete clinical success rates of 37% following adrenalectomy for primary aldosteronism (PA), based on the former blood pressure (BP) threshold of <140/90 mmHg. This study evaluated outcomes using the current guideline BP threshold of <130/80 mmHg. METHODS: We conducted a retrospective cohort study using the Epic COSMOS database of 1320 adults who underwent adrenalectomy for PA (2013-2024). Inclusion criteria included preoperative plasma aldosterone measurement and ambulatory BP measurements within 6 months and 6-18 months post-adrenalectomy. After exclud

[Evaluation of a cut-off value for the plasma aldosterone-to-renin ratio in screening for primary aldosteronism in different age and gender groups].

Objective: To explore the optimal cut-off value of aldosterone-to-renin ratio (ARR) for primary aldosteronism screening in hypertensive populations stratified by sex and age. Methods: This study was a cross-sectional study. Patients who were diagnosed with hypertension from November 2016 to December 2023 at the First Affiliated Hospital of Dalian Medical University were included. Upright direct renin concentration (DRC) and plasma aldosterone concentration (PAC) were measured using chemiluminescence, and the ARR was calculated as PAC/DRC. Patients were divided into primary aldosteronism and pr