Are We Only Detecting the Tip of the Iceberg? A Nationwide Study on Primary Aldosteronism with up to 8-Year Follow-up

Long-term follow-up studies on primary aldosteronism (PA) are lacking. We aim to review results of diagnostic procedures and histopathology for patients diagnosed during 2012–2016 in Iceland, compare unilateral (UD) and bilateral disease (BD) and assess treatment response. Thirty-two patients aged 28–88 were diagnosed and treated according to guidelines. The majority had BD. Everyone needed potassium supplementation at case detection. We saw a reduction in systolic blood pressure (p < .001, both groups), antihypertensive agents (p = .002 UD and p = .04 BD) and potassium supplementation (p < .001, both groups). Similar treatment response was seen in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland.

原发性醛固酮增多症（primary aldosteronism, PA）的长期随访研究目前仍较为匮乏。本研究旨在回顾冰岛2012至2016年确诊患者的诊断检查与组织病理学结果，对比单侧病变（unilateral disease, UD）与双侧病变（bilateral disease, BD）的临床特征，并评估其治疗应答效果。本研究共纳入32名年龄介于28至88岁的患者，所有患者均按照临床诊疗指南完成确诊与治疗。其中多数患者为双侧病变，所有患者在确诊时均需补充钾剂。研究观察到，两组患者的收缩压（两组均p < 0.001）、降压药物使用剂量（UD组p=0.002，BD组p=0.04）以及钾剂补充剂量（两组均p < 0.001）均显著降低。两个亚组的治疗应答效果相似。低血钾症发生比例与总病例数的比值提示，冰岛地区存在重症原发性醛固酮增多症漏诊情况严重的问题。