EVALUATION OF YOUNG ONSET HTN SECONDARY HTN & PRIMARY HYPERALDOSTERONISM

In context of following patient who got admitted with Hypertensive urgency ( BP -240/120 mmHg .

We evaluated her for secondary causes of Hypertension by reviewing literature and investigations that are available in our institution .

https://keerthykasa80.blogspot.com/2021/09/a-35-year-old-female-with-hypertensive.html

1- http://emedicine.medscape.com/article/241381-overview

Approximately 90-95% of adults with hypertension have primary hypertension, whereas secondary hypertension accounts for around 5-10% of the cases. [11] However, secondary forms of hypertension, such as primary hyperaldosteronism, account for 20% of resistant hypertension (hypertension in which BP is >140/90 mm Hg despite the use of medications from 3 or more drugs (1 of which is a thiazide diuretic).

Primary aldosteronism (15-20%) is commoner than pheochromocytoma (0.6%)

: 25% of patients with primary aldosteronism can have normal Potassium .These proportion of patients with normal Potassium ,found to have aldosterone producing adenoma .

And two most common cause of sporadic primary aldosteronism is adrenal adenoma and bilateral adrenal hyperplasia .They account for more than 90 % cases sir .

2)Screening test - plasma aldosterone to  Renin ratio - 90% sen ,91% specificity

: For the levels of aldosterone  more than 20 ng / ml 

And ratio more than 30:1

3) https://pubmed.ncbi.nlm.nih.gov/16509213/

Retrospective analysis of  187 patients .

7 patient had - normal Potassium .

More than 2/3 rd patients had adrenal adenoma .(135 pt) 

All patients underwent CT abdomen for adrenal adenoma / hyperplasia .

The ratio of plasma aldosterone concentration (ng/dl) to plasma renin activity (ng/ml/h) was above 20 in all patients with aldosterone-producing adenoma . 

4) https://pubmed.ncbi.nlm.nih.gov/12766605/ 

Small population - 49 patients only . 

The PPV of adrenal imaging was 97.6% for NCS, 85.0% for CT scan (P=0.04) and 83.3% for MRI (P=0.03), and the sensitivity was 85.4%, 85.0% and 74.1%, respectively (P=NS) 

High resolution CT may diagnosis tumor as small as 0.3 cm ,PPV-90% .

If non diagnostic - 

Adenoma may be detected by adrenal scintigraphy after dexamethasone suppression test ,but sensitivity is decreased of tumor size less than 1.5 cm .

For unilateral aldosterone secretion Sens and specificity of adrenal venous sampling -95 and 100 % 

Superior to CT abdomen