| Objective:We prospectively investigated the prevalence,characteristics and outcomes of primary aldosteronism(PA)in newly diagnosed hypertensives in China.Method:In a large community health center,consecutive hypertensive patients were included and blood samples were collected for plasma aldosterone concentration(PAC)and plasma renin concentration(PRC),then aldosterone-renin ratio(ARR)was calculated.Patients with positive screening test(an ARR>20pg/μIU and PAC≥100pg/ml)underwent captopril challenge test and/or saline infusion test for confirmation.Adrenal CT scan or adrenal vein sampling was used for subtyping.PA patients diagnosed at early stage of hypertension(average duration<lyear)were followed up for one year and clinical outcomes were compared with PA patients diagnosed after prolonged hypertension with an average duration of 7.8 years.Results:1020 newly diagnosed hypertensive patients were screened.Forty were diagnosed with PA,948 with non-PA.Thirty-two patients were diagnosed as "probable PA" due to positive screening but failure to complete the confirmatory tests.The overall prevalence of PA was 4.0%,without significant difference in hypertension stage(4.1%in stage 1,4.2%in stage 2,3.8%in stage 3).Compared to non-PA,PA patients more frequently displayed microalbuminuria(p=0.031),but the incidence of cardiovascular events was not different(p=0.927).For patients treated with surgery,complete clinical success rate was 85.7%,higher than that of PA patients diagnosed after prolonged hypertension.For patients treated with medication,blood pressure control rate was 79.3%,higher than that of PA patients diagnosed after prolonged hypertension.Conclusions:The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4.0%.PA screening in newly diagnosed hypertensive patients leads to better clinical outcomes.Objective:To evaluate the clinical characteristics of aldosterone-and cortisol-co-producing adenomas,and the possible factors affecting autonomic secretion of cortisol.Method:This study was composed of two separate parts.In the first part,we retrospectively analysis 69 patients with APA,23 patients with CPA and 20 patients with A/CPA from Chongqing Primary Aldosteronism Study cohort.Clinical and biochemical characteristics,endocrine hormones,immunohistochemical staining score(H-score)and gene mutation in the adrenal tumors were analyzed in all three subgroups of patients with adrenocortical adenomas.In the second part,176 patients with APA who underwent lmg overnight dexamethasone suppression test(lmg-DST)were included.The possible factors affecting the autonomous secretion of cortisol in APA were identified by logistic regression analysis,and the correlation with clinical and immunohistochemical staining scores was analyzed.Results:The tumor diameter of A/CPA patients(27.6±9.1mm)was significantly larger than that of APA patients(16.9±6.8mm).Compared to APA patients,A/CPA patients had higher plasma cortisol after lmg DST[166.5(93.0-214.98)vs.27.7(20.6-34.2)nmol/L,p<0.001].Compared with CPA patients,A/CPA patients had a significantly lower plasma cortisol value after 2mg dexamethasone suppression test[355.9(162.9-695.1)vs.179.3(79.2-333.2)nmol/L,p=0.0025].Tumors of A/CPAs had higher H-score of CYP11B1 and lower H-score of CYP11B2,compared with tumors of APA.Multivariate logistic analysis indicated that tumor diameter and age were strongly related to the autonomous secretion of cortisol in APAs,correlation analysis showed that tumor diameter had a significant positive correlation with cortisol value after lmg-DST(r=0.309,p=0.0058)and H-score of CYP11B1(r=0.269,p=0.01)but negative correlation with H-score of CYP11B2(r=-0.243,p=0.019).Conclusions:Autonomous secretion of cortisol is not uncommon in APAs,characterized by older age and larger tumor diameter.A higher proportion of cells expressing CYP11B1 is associated with autonomous secretion of cortisol in APAs. |
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