From AHA delay in DX Conn's

[Guest guest]

Skip to main page content

Hypertension Home

•

Subscriptions

•

Archives

•

Feedback

•

Authors

•

Help

•

AHA Journals Home

Search:

GO

Advanced Search

User Name Password Sign In

Expand+

Hypertensionhyper.ahajournals.org

Hypertension. 2008; 52: e22 Published online before print July 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697

Letters to the Editor

Delay in the Diagnosis of Conn's Syndrome: A Single-Center Experience Over 30 Years

Tarvinder S. Dhanjal,

D. Gareth Beevers

+ Author Affiliations

University Department of Medicine, City Hospital, Birmingham, United Kingdom

Next Section

Introduction

To the Editor:

The study reported by Rossi et al1 addressed predictors of outcome in aldosterone-producing adenoma (APA) patients postadrenalectomy. The time-dependent process of adverse vascular remodeling, determined by an increased media/lumen ratio of resistance arteries, was hypothesized to predict a poorer response to adrenalectomy. Indeed, the media/lumen ratio and the known duration of hypertension were significant predictors of response to adrenalectomy in APA patients who were categorized into cured, markedly improved, or mildly improved subgroups. In particular, the mean duration of hypertension in the 3 groups was 2.6±0.9, 8.0±1.3, and 17.3±5.0 years, respectively.

We encountered a patient who was referred to us for investigation of hypertension 15 years after first diagnosis.2 We confirmed an APA, diameter 3.8 cm, possibly the largest APA in the English literature. We therefore investigated whether the duration of hypertension was related to tumor size, but we found no relationship. We investigated a total of 19 patients with APA and 10 patients with idiopathic hyperaldosteronism (IHA) from our center over the past 30 years. The Table shows the delay in referral from primary care to the hypertension clinic (delay 1), the delay in diagnosis of APA/IHA within the hypertension clinic (delay 2), and the total duration of hypertension to diagnosis of APA/IHA (total delay). We found that the duration of pre-existing hypertension to diagnosis in our APA patients was ≈8 years, which was very similar to the subgroup of APA patients reported by Rossi et al whom underwent adrenalectomy resulting in a markedly improved BP outcome. The diagnosis of APA was made within 1 year (0.8±0.3 years) of attending our hypertension clinic so most of the delay in diagnosis occurs within the primary care setting (7.2±1.6 years).

View this table:

In this window

In a new window

Table. Delay in the Diagnosis of Conn's Syndrome

APA patients with an extensive history of preexisting hypertension are likely to have associated target organ damage in the kidney and vasculature, thus contributing to persistent hypertension despite successful adrenalectomy. Indeed, those APA patients reported by Rossi et al,1 who were cured by adrenalectomy, had pre-existing hypertension for a mean duration of <3 years. Furthermore, Fukudome et al3 reported a mean duration of pre-existing hypertension of 6 years in their APA patients cured by adrenalectomy and 10 years in those who were not cured.

Primary hyperaldosteronism is the most common endocrine cause of hypertension. Our observations, along with those reported by Rossi et al,1 emphasize that increased awareness is necessary by primary health care professionals to minimize the delay in diagnosis and achieve a prompt surgical cure.

Previous SectionNext Section

Acknowledgments

Disclosures

None.

Previous Section

References

↵

Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension. 2008; 51: 1366–1371.

Abstract/FREE Full Text

↵

Felmeden DC, Gearty JG, Dawkins DM, Beevers G. Hypertension due to a giant aldosterone-secreting adenoma. J Renin Angiotensin Aldosterone Syst. 2001; 2: 43–44.

FREE Full Text

↵

Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy. Hypertens Res. 2002; 25: 11–18.

CrossRefMedline

CiteULike

Complore

Connotea

Delicious

Digg

Facebook

Google+

Mendeley

Reddit

Technorati

Twitter

What's this?

Articles citing this article

Response to Delay in the Diagnosis of Conn's Syndrome: A Single-Center Experience Over 30 Years Hypertension. 2008;52:e23,

Full Text

PDF

« Prev Article | Next Article »Table of Contents

This Article

Hypertension. 2008; 52: e22 Published online before print July 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697

ExtractFree

» Full TextFree

PDFFree

All Versions of this Article:

HYPERTENSIONAHA.108.117697v1

52/3/e22 most recent

- Classifications

Letters to the Editor

- Services

E-mail this article to a friend

Alert me when this article is cited

Alert me if a correction is posted

Similar articles in this journal

Similar articles in PubMed

Download to citation manager

Request Permissions

+ Citing Articles

View citing article information

Citing articles via Google Scholar

+ Google Scholar

Articles by Dhanjal, T. S.

Articles by Beevers, D. G.

Search for related content

+ PubMed

PubMed citation

Articles by Dhanjal, T. S.

Articles by Beevers, D. G.

Medline Plus Health Information

High Blood Pressure

+ Related Content

No related web pages

+ Related Collections

Other hypertension

Clinical Studies

+ Social Bookmarking

CiteULike

Complore

Connotea

Delicious

Digg

Facebook

Google+

Mendeley

Reddit

Technorati

Twitter

What's this?

Navigate This Article

Top

Acknowledgments

References

Current Issue

March 2012

Alert me to new issues of Hypertension »

About Hypertension

Instructions for Authors

Online Submission/Peer Review

Editorial Board

RSS Feeds

Advertiser Information

Spotlight

Most

Most Read

Most Cited

Most Read

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Update on the Use of Antihypertensive Drugs in Pregnancy

Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research

Relation Between Blood Pressure and Vascular Events and Mortality in Patients With Manifest Vascular Disease: J-Curve Revisited» View all Most Read articles

Most Cited

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Prevalence of Hypertension in the US Adult Population : Results From the Third National Health and Nutrition Examination Survey, 1988-1991

Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients

Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population : Data From the Health Examination Surveys, 1960 to 1991

Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension [published erratum appears in Hypertension 1995 Mar;25(3):462] » View all Most Cited articles

Alternate International Access [more info]

Copyright © 2012 by American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.

Print ISSN: 0194-911X

Online ISSN: 1524-4563