Chulalongkorn Medical Journal


Background : Primary aldosteronism (PA) is a cause of secondary hypertensionwhich characterized by hypertension, increased plasmaaldosterone concentration (PAC), and suppressed plasma reninactivity (PRA).Objective : To study the prevalence of primary aldosteronism and clinicalclue for diagnosis of PA.Setting : Prapokklao Hospital, Chanthaburi Province.Materials and Methods : All patients whose diagnoses of primary aldosteronism fromOctober 2006 - March 2012 were reviewed.Results : The prevalence of PA at Prapokklao Hospital was 0.15%(20 cases of PA) of HT. 70% of cases were female. The age atthe diagnosis of HT ranged from 32.58 to 72.92 (mean = 46.47).The mean time to diagnosis of PA since HT was 78.85 months(range of 1 to 295 months). The mean of potassium level was3.0 (2.1 to 3.8) mEq/dL. The prevalence of co-morbidities wereas follow diabetes/ impair fasting glucose 30%, dyslipidemia 30%,chronic kidney disease 20%, obesity 15%. The aldosterone torennin ratio (ARR) was 16.56 - 282.5 ng/mL to ng/mL/hr. Theabnormalities of adrenal gland were demonstrated by CT withseven cases of unilateral macroadenoma, five cases of adrenallimb thickening, three cases of unilateral microadenomas.Medical or surgical treatment significantly resulted in improvedhypokalemia and hypertension. Five cases underwentadrenalectomy and the others were treated by antihypertensivemedication especially aldosterone antagonist. There were fourcases that still require potassium replacement eventually at lowerdosage.Conclusion : The prevalence of primary aldosteronism at Prapokklao hospitalwas 0.15% which extremely lower than that of the reviewedliteratures. The most important clue that triggered the investigationwas ‘hypertension with hypokalemia’. The screening schememight have to be initiated earlier, before patients present anobvious clinical of hypokalemia to include more cases.


Faculty of Medicine, Chulalongkorn University

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