title: Primary aldosteronism in patients with acute stroke: prevalence and diagnosis during initial hospitalization.
abstract: BACKGROUND
  Hypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension. The prevalence of PA in stroke patients has never been reported. The aim of this study was to elucidate the prevalence of PA.
  
  
  METHODS
  A total of 427 consecutive patients with acute stroke were prospectively enrolled for this study. The screening tests were performed at the initial visit and a week after admission by measuring plasma aldosterone concentration and plasma renin activity. The rapid adrenocorticotropic hormone (ACTH) test was performed as the confirmatory test when both screening tests were positive. The primary endpoint was a final diagnosis of PA.
  
  
  RESULTS
  The sensitivity of the dual screening system for the diagnosis of PA was 88.2 %, and PA was finally diagnosed in 4.0 % of acute stroke patients and in 4.9 % of stroke patients with a history of hypertension. Patients with PA were less likely to be male and have diabetes, and they had higher blood pressure at the initial visit, lower potassium concentration, and more intracerebral hemorrhage. The rapid ACTH test was performed safely even in acute stroke patients.
  
  
  CONCLUSIONS
  The prevalence of PA is not low among acute stroke patients. Efficient screening of PA should be performed particularly for patients with risk factors.
  
  
  BACKGROUND
  UMIN-CTR; UMIN000011021 . Trial registration date: June 23, 2013 (retrospectively registered).
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.|Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyaji
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kawabata
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.|Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Joki
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Seki
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kamide
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tamase
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shima
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery and Stroke Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: Department of Metabolism and Endocrinology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Hirotatsu
authors.initials: H
authors.lastname: Nakaguchi
authors.affiliation: Department of Metabolism and Endocrinology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Minami
authors.affiliation: Department of Metabolism and Endocrinology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Tsunoda
authors.affiliation: Department of Metabolism and Endocrinology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Metabolism and Endocrinology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. ftanaka@yokohama-cu.ac.jp.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D010912:Pituitary-Adrenal Function Tests; D015995:Prevalence; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology*
chemical_list: D000450:Aldosterone; D012083:Renin
keywords: Intracranial hemorrhage; Ischemic stroke; Primary aldosteronism; Risk factor; Secondary hypertension; Stroke