title: Long-term re-evaluation of primary aldosteronism after medical treatment reveals high proportion of normal mineralocorticoid secretion.
abstract: OBJECTIVE
  In most cases of primary aldosteronism (PA), An adrenal aldosterone-secreting tumor cannot be reasonably proven, so these patients undergo medical treatment. Controversial data exist about the evolution of PA after medical therapy: long-term treatment with mineralocorticoid antagonists has been reported to normalize aldosterone levels but other authors failed to find remission of mineralocorticoid hypersecretion. Thus, we planned to retest aldosterone secretion in patients with medically treated PA diagnosed at least 3 years before.
  
  
  METHODS
  Retrospective, cross-sectional study.
  
  
  METHODS
  The same workup for PA as at diagnosis (basal aldosterone to renin activity ratio (ARR) and aldosterone suppression test) was performed after stopping interfering drugs and low-salt diet, in 34 subjects with PA diagnosed between 3 and 15 years earlier, by case finding from subgroups of hypertensive patients at high risk for PA. Criteria for persistence of PA were the same as at diagnosis (ARR (pg/ml per ng per ml per h) >400, aldosterone >150 pg/ml basally, and >100 pg/ml after saline infusion) or less restrictive.
  
  
  RESULTS
  PA was not confirmed in 26 (76%) of the patients and also not in 20 (59%) using the least restrictive criteria suggested by international guidelines. Unconfirmed PA was positively associated with female sex, higher potassium levels, longer duration of hypertension, and follow-up, but not with adrenal mass, aldosterone levels at diagnosis, and treatment with mineralocorticoid antagonists.
  
  
  CONCLUSIONS
  This study suggests that mineralocorticoid hyperfunction in patients with PA after medical treatment may decline spontaneously. Higher potassium concentration and duration of treatment seem to increase the probability of this event.
authors: Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University of Turin, Torino, Italy.
authors: Barbara
authors: B
authors: Lucatello
authors: Andrea
authors: A
authors: Benso
authors: Isabella
authors: I
authors: Tabaro
authors: Elena
authors: E
authors: Capello
authors: Mirko Parasiliti
authors: MP
authors: Caprino
authors: Lisa
authors: L
authors: Marafetti
authors: Denis
authors: D
authors: Rossato
authors: Salvatore E
authors: SE
authors: Oleandri
authors: Ezio
authors: E
authors: Ghigo
authors: Mauro
authors: M
authors: Maccario
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000097:blood / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008901:Mineralocorticoids; D000450:Aldosterone; D005438:Fludrocortisone