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dc.contributor.authorSigurjonsdottir, Helga Agusta
dc.contributor.authorGronowitz, Mikael
dc.contributor.authorAndersson, Ove
dc.contributor.authorEggertsen, Robert
dc.contributor.authorHerlitz, Hans
dc.contributor.authorSakinis, Augustinas
dc.contributor.authorWangberg, Bo
dc.contributor.authorJohannsson, Gudmundur
dc.date.accessioned2013-09-12T14:04:10Z
dc.date.available2013-09-12T14:04:10Z
dc.date.issued2012
dc.date.submitted2013-09-12
dc.identifier.citationBMC Endocr Disord 2012, 12:17en_GB
dc.identifier.issn1472-6823
dc.identifier.pmid22958674
dc.identifier.doi10.1186/1472-6823-12-17
dc.identifier.urihttp://hdl.handle.net/2336/301492
dc.descriptionTo access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractThe existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.
dc.description.sponsorshipHealth & Medical Care Committee of the Regional Executive Board, Region Vastra Gotaland, Swedenen_GB
dc.language.isoenen
dc.publisherBioMed Centralen_GB
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3515501/en_GB
dc.relation.urlhttp://www.biomedcentral.com/1472-6823/12/17en_GB
dc.relation.urlhttp://dx.doi.org/10.1186/1472-6823-12-17en_GB
dc.rightsArchived with thanks to BMC endocrine disordersen_GB
dc.titleUnilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.en_GB
dc.identifier.journalBMC endocrine disordersen_GB
dc.rights.accessOpen Access - Opinn aðganguren
html.description.abstractThe existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.


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