Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights
Several decades have passed since the description of the first patient with primary aldosteronism (PA). PA was initially classified in two main forms: aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). However, the pathogenesis of PA has now been shown to be far more comple...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1372683/full |
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| author | Takumi Kitamoto Yutaro Ruike Hisashi Koide Kosuke Inoue Yoshiro Maezawa Masao Omura Kazuki Nakai Yuya Tsurutani Jun Saito Katsuhiko Kuwa Koutaro Yokote Tetsuo Nishikawa |
| author_facet | Takumi Kitamoto Yutaro Ruike Hisashi Koide Kosuke Inoue Yoshiro Maezawa Masao Omura Kazuki Nakai Yuya Tsurutani Jun Saito Katsuhiko Kuwa Koutaro Yokote Tetsuo Nishikawa |
| author_sort | Takumi Kitamoto |
| collection | DOAJ |
| description | Several decades have passed since the description of the first patient with primary aldosteronism (PA). PA was initially classified in two main forms: aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). However, the pathogenesis of PA has now been shown to be far more complex. For this reason, the traditional classification needs to be updated. Given the recent advancements in our understanding of PA pathogenesis, we should reevaluate how frequent PA cases are, beginning with the reconstruction of the screening strategy. Recent studies consistently indicated that PA has been identified in 22% of patients with resistant hypertension and 11% even in normotensives. The frequency is influenced by the screening strategy and should be based on understanding the pathogenesis of PA. Progress has been made to promote our understanding of the pathogenesis of PA by the findings of aldosterone driver mutations, which have been found in normotensives and hypertensives. In addition, much clinical evidence has been accumulated to indicate that there is a spectrum in PA pathogenesis. In this review, we will summarize the recent progress in aldosterone measurement methods based on LC-MS/MS and the current screening strategy. Then, we will discuss the progress of our understanding of PA, focusing on aldosterone driver mutations and the natural history of PA. Finally, we will discuss the optimal strategy to improve screening rate and case detection. |
| format | Article |
| id | doaj-art-d141ae8d845849b6be37c0a5519f56d3 |
| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj-art-d141ae8d845849b6be37c0a5519f56d32025-01-14T05:10:18ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-01-011510.3389/fendo.2024.13726831372683Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insightsTakumi Kitamoto0Yutaro Ruike1Hisashi Koide2Kosuke Inoue3Yoshiro Maezawa4Masao Omura5Kazuki Nakai6Yuya Tsurutani7Jun Saito8Katsuhiko Kuwa9Koutaro Yokote10Tetsuo Nishikawa11Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, JapanDepartment of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, JapanDepartment of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, JapanDepartment of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, JapanEndocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, JapanEndocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, JapanEndocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, JapanEndocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, JapanNational Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Tsukuba, JapanDepartment of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, JapanEndocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, JapanSeveral decades have passed since the description of the first patient with primary aldosteronism (PA). PA was initially classified in two main forms: aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). However, the pathogenesis of PA has now been shown to be far more complex. For this reason, the traditional classification needs to be updated. Given the recent advancements in our understanding of PA pathogenesis, we should reevaluate how frequent PA cases are, beginning with the reconstruction of the screening strategy. Recent studies consistently indicated that PA has been identified in 22% of patients with resistant hypertension and 11% even in normotensives. The frequency is influenced by the screening strategy and should be based on understanding the pathogenesis of PA. Progress has been made to promote our understanding of the pathogenesis of PA by the findings of aldosterone driver mutations, which have been found in normotensives and hypertensives. In addition, much clinical evidence has been accumulated to indicate that there is a spectrum in PA pathogenesis. In this review, we will summarize the recent progress in aldosterone measurement methods based on LC-MS/MS and the current screening strategy. Then, we will discuss the progress of our understanding of PA, focusing on aldosterone driver mutations and the natural history of PA. Finally, we will discuss the optimal strategy to improve screening rate and case detection.https://www.frontiersin.org/articles/10.3389/fendo.2024.1372683/fullprimary aldosteronismaldosterone measurementscreening testlow renin hypertensivesomatic mutation |
| spellingShingle | Takumi Kitamoto Yutaro Ruike Hisashi Koide Kosuke Inoue Yoshiro Maezawa Masao Omura Kazuki Nakai Yuya Tsurutani Jun Saito Katsuhiko Kuwa Koutaro Yokote Tetsuo Nishikawa Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights Frontiers in Endocrinology primary aldosteronism aldosterone measurement screening test low renin hypertensive somatic mutation |
| title | Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights |
| title_full | Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights |
| title_fullStr | Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights |
| title_full_unstemmed | Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights |
| title_short | Shifting paradigms in primary aldosteronism: reconsideration of screening strategy via integrating pathophysiological insights |
| title_sort | shifting paradigms in primary aldosteronism reconsideration of screening strategy via integrating pathophysiological insights |
| topic | primary aldosteronism aldosterone measurement screening test low renin hypertensive somatic mutation |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1372683/full |
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