Nonalcoholic Fatty Liver Disease in Primary Aldosteronism: A Pilot Study
Francesco FalloA. PozzaM. TecchioFrancesco TonaNicoletta SoninoMario ErmaniCristiana CatenaChiara BertelloPaolo MulateroNicoletta SabatoBruno FabrisLeonardo A. Sechi
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Abstract:
An impairment of glucose metabolism, contributing to the increased cardiovascular risk, has been shown in primary aldosteronism (PA). Insulin resistance is associated with nonalcoholic fatty liver disease (NAFLD) and may play a role in its pathophysiology. The aim of this study was to investigate the association between NAFLD and PA, and to identify determinants of NAFLD in this condition.A total of 40 patients with PA, 40 sex-, age-, and body mass index matched patients with low-renin essential hypertension (LREH) and 40 normotensive subjects were studied. According to ultrasound detection of fatty liver, each group was subdivided in two subsets: with NAFLD and without NAFLD. Patients with diabetes, obesity, and hyperlipidemia were excluded.Prevalence of NAFLD in PA was similar to that observed in LREH patients, and higher (P < 0.01) than in normotensive controls. Serum potassium was lower in PA than in LREH patients with NAFLD (P < 0.001), while it was similar in PA and LREH patients without NAFLD. At univariate analysis, plasma aldosterone, homeostasis model assessment (HOMA) index and hypokalemia were determinants of NAFLD in PA (P < 0.05), while HOMA index was associated with NAFLD in LREH (P < 0.05). At multivariable analysis, only hypokalemia remained associated with NAFLD in PA (P = 0.02).The results of this pilot study suggest that, in the absence of major risk factors for liver disease, NAFLD is a frequent finding in PA. Patients with PA and hypokalemia are more insulin resistant and have higher prevalence of NAFLD than those with normokalemia, indicating greater risk for metabolic and liver disease in this subgroup.Keywords:
Primary Aldosteronism
Univariate analysis
Hyperlipidemia
Patients presenting with primary aldosteronism experience more cardiovascular events than patients with essential hypertension independent of blood pressure. Therefore, the presence of primary aldosteronism should be detected, not only to determine the cause of hypertension, but also to prevent such complications. This review focuses on human data regarding increased end-organ damage and comorbidities in primary aldosteronism. Special emphasis is put on the effects of aldosterone excess on blood vessels, the heart, the kidney, and the brain. The data reviewed in our article demonstrate that primary aldosteronism is associated with a prevalence of cerebro-, cardiovascular and renal complications that are out of proportion to the blood pressure and benefits substantially from treatment in the long term. In this view, adrenalectomy and aldosterone antagonist treatment seem to be of considerable therapeutic value to control and limit the progression of comorbidities in primary aldosteronism.
Primary Aldosteronism
Secondary hypertension
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Primary aldosteronism is the most common cause of secondary hypertension,the prevalence of which has been more than 10% in the population of hypertension.The treatment of primary aldosteronism depends on its special subtypes,therefore the subtype diagnosis is very important.The imaging examination methods include CT scan,MRI,scintigraphy and adrenal venous sampling.All confirmed patients should receive adrenal CT scans,and adrenal venous sampling is the golden standard of primary aldosteronism classification and positioning.Here is to make a review of the diagnostic value of the imaging examinations for primary aldosteronism.
Primary Aldosteronism
Gold standard (test)
Secondary hypertension
Hyperaldosteronism
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Primary aldosteronism is one of the most common forms of secondary arterial hypertension. Adrenalectomy is effective in patients with proven unilateral hypersecretion of aldosterone whereas pharmacotherapy is indicated in bilateral forms of the disease. We can meet the opinion that in patients with confirmed primary aldosteronism and finding ofsuprarenal adenoma > or = 1 cm on computed tomography (CT) scanning, adrenalectomy can be recommended without further investigation. On the other hand we can perform adrenal venous sampling (AVS) to prove unilateral overproduction of aldosterone.To evaluate whether AVS is necessary in all patients with unilateral adenoma > or = 1 cm.We analyzed data from patients with proven primary aldosteronism, CT finding of adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland, and successfully performed AVS.Out of 107 patients with proven primary aldosteronism, indicated for AVS, we included 30 patients with CT finding of suprarenal adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland and successful AVS. Unilateral overproduction of aldosterone was found only in 17 cases (56.7%), the results in remaining 13 patients (43.3%) did not confirm activity of adenoma.Our results support necessity of performing AVS in all patients with primary aldosteronism in whom surgical treatment is considered, CT confirmation ofan adenoma is insufficient in this indication.
Primary Aldosteronism
Adrenocortical adenoma
Secondary hypertension
Adrenal adenoma
Hyperaldosteronism
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Objective: To investigate the relation of Shanghai elderly hyperlipidemia and fatty liver. Methods: The physical examination data of 524 elderly people from Wuliqiao street community health service center were collected. The relationship between hyperlipidemia and fatty liver in the elderly was analyzed by gender and age,the detection rates of hyperlipidemia and fatty liver of different gender and age were compared. Results: The detection rate of triglycerides in the eldly with fatty liver was higher than that in the eldly without fatty liver( P 0. 01). The detection rate of fatty liver in female( 63. 89%) was higher than that in male( 49,5%)( P 0. 01). The detection rate of fatty liver in the elderly with high triglycerides was higher than that in the elderly with normal triglycerides( P 0. 01). Conclusions: Controlling blood lipid levels can reduce the incidence of fatty liver,and prevent Cardiacerebrovascular disease
Hyperlipidemia
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Objective: Saline infusion test (SIT) requires 2 l of isotonic saline for intravenous infusion over 4 h to suppress plasma aldosterone concentration (PAC). To shorten the procedure time and minimize the volume load, we study the performance of SIT at 1, 2 and 4 h for diagnosing primary aldosteronism. Methods: This is a cross-sectional study. PAC was measured before and 1, 2 and 4 h after saline infusion at a rate of 500 ml/h in patients suspected to have primary aldosteronism. Primary aldosteronism was diagnosed based on 4 h PAC, adrenal imaging and/or adrenal venous sampling (AVS). Results: Of the 93 patients, 32 had primary aldosteronism. The area under the receiver operating characteristic (ROC) curve of the 1, 2 and 4 h PAC were not statistically different. All of the nonprimary aldosteronism group had a 1 h PAC lower than 15 ng/dl and all of the primary aldosteronism group had a 1 h PAC higher than 5 ng/dl. Nearly 30% of the nonprimary aldosteronism and primary aldosteronism groups had a 1 h PAC between 5 and 15 ng/dl (equivocal range) and could be discriminated by using percentage suppression of 1 h PAC from baseline. Using 1 h PAC of more than 15 ng/dl together with percentage suppression of 1 h PAC from baseline of less than 60 when 1 h PAC was 5–15 ng/dl, primary aldosteronism could be detected with a sensitivity of 93.7% and specificity of 96.7%. Conclusion: The 1 h SIT has a similar diagnostic performance to the standard SIT. Using 1 h PAC together with percentage suppression from baseline when 1 h PAC is equivocal, primary aldosteronism can be diagnosed with good accuracy.
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Hyperaldosteronism
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Purpose of review The purpose of this review is to briefly summarize current knowledge on diagnosis and treatment of primary aldosteronism, the most frequent cause of endocrine hypertension. Recent findings The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. The detection of primary aldosteronism is of particular importance, not only because it provides an opportunity for a targeted treatment but also because it has been extensively demonstrated that patients affected by primary aldosteronism are more prone to cardiovascular events and target organ damage than patients with essential hypertension. The diagnosis of primary aldosteronism is a three-step process; screening, confirmation and subtype diagnosis. Summary We review, the strategies to correctly identify primary aldosteronism, highlighting the central role of the new guidelines and the diagnostic aspects still under debate.
Primary Aldosteronism
Secondary hypertension
Essential hypertension
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Primary Aldosteronism
Essential hypertension
Secondary hypertension
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The prevalence of aldosteronism increases with the level of recognition and evaluation increased.It is the most common cause of secondary hypertension.Elevated aldosteronism is important for screening and diagnosis of primary aldosteronism.Adrenal vein sampling can confirm the location and is helpful for treatment decision.
Primary Aldosteronism
Secondary hypertension
Hyperaldosteronism
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Primary Aldosteronism
Hyperaldosteronism
Essential hypertension
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1. Objective Primary aldosteronism is clinically characterized by hypertension and hypokalemia. The purpose of this article is to report our case about a female patient with suspected primary aldosteronism. 2. Methods We diagnosed her as Soyangin Heat Sensation in chest and treated with Yangkyuksanhwa-rang and Hyungbangjihwang-tang. And potassium replacement therapy was applied to correct hypokalemia. 3. Results and Conclusions In this case, through Herb-medication, most symptoms were improved except dry mouth, Bur hypokalemia was not corrected, and primary aldosteronism was suspected on the basis of the blood results and symptoms.
Primary Aldosteronism
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