title: Primary aldosteronism and its various clinical scenarios.
abstract: BACKGROUND
  Primary aldosteronism is the most frequent endocrine cause of secondary hypertension. Aldosterone excess damages the cardiovascular system.
  
  
  OBJECTIVE
  We compared biochemical; morphological, and cardiovascular risk differences among hypokalemic and normokalemic primary aldosteronism. We evaluated either both presentations correspond to two different entities or a unique disease in different evolutive stage.
  
  
  METHODS
  This is a retrospective study including 157 patients with primary aldosteronism divided into two groups: typical presentation (serum potassium < 3.5 mmol/l, n = 87) and atypical presentation (serum potassium > 3.5 mmol/l, n = 70).
  
  
  RESULTS
  The typical presentation group showed higher family background of ischemic heart disease (P = 0.028), plasmatic aldosterone levels (P = 0.001), and cardiovascular added risk (P = 0.013). Although kalemia was corrected in the hypokalemic group after specific treatment, typical presentation maintained lower levels. Predictors of typical presentation were the highest tertile of aldosterone level, baseline DBP, and a longer evolution of hypertension. Aldosterone serum levels increased along time in primary aldosteronism and it can be considered as the most discriminative factor for the type of presentation.
  
  
  CONCLUSIONS
  Primary aldosteronism presentation along with normokalemia or hypokalemia could be the same disease at different evolution stages. Adequate detection of normokalemic primary aldosteronism deserves an early and intentional diagnostic attitude.
authors.affiliation: aUnidad de Hipertensión, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UCM, Madrid, Spain bUnidad de Metodología y Epidemiología Clínica, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Facultad de Enfermería, UCM, Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
authors.forename: María
authors.initials: M
authors.lastname: Abad-Cardiel
authors.forename: Beatriz
authors.initials: B
authors.lastname: Alvarez-Alvarez
authors.forename: José A
authors.initials: JA
authors.lastname: García-Donaire
authors.forename: Cristina Fernández
authors.initials: CF
authors.lastname: Pérez
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D007008:Hypokalemia / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000450:Aldosterone; D011188:Potassium