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DOES NORMOTENSIVE PA TRULY EXIST?

DOES NORMOTENSIVE PA TRULY EXIST?. A.H. Ghanooni Fellowship of Endocrinology October 2016. Causes of hypokalemia. Clinical features of primary aldosteronism. Lack of edema Hypertension  Hypokalemia: an inconsistent finding Metabolic alkalosis  Mild hypernatremia Hypomagnesemia 

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DOES NORMOTENSIVE PA TRULY EXIST?

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  1. DOES NORMOTENSIVE PA TRULY EXIST? A.H. Ghanooni Fellowship of Endocrinology October 2016

  2. Causes of hypokalemia

  3. Clinical features of primary aldosteronism • Lack of edema • Hypertension  • Hypokalemia: an inconsistent finding • Metabolic alkalosis  • Mild hypernatremia • Hypomagnesemia  • Other renal effects : increased urinary albumin excretion

  4. Design and patients Retrospective comparison of 10 normotensive and 168 hypertensive patients with PA for office or ambulatory blood pressure, serum potassium, plasma aldosterone and renin concentrations; the aldosterone : renin ratio, and tumour size. • Comparison of initial hormonal pattern and drop in blood pressure following adrenalectomy in five normotensive and nine hypertensive patients matched for age, sex and body mass index.

  5. Conclusions  Blood pressure may be normal in patients with well-documented PA. The occurrence of hypokalemia, despite a normal blood pressure profile, suggests that protective mechanisms against hypertension are present in normotensive patients.

  6. Since Brooks et al. first described normotensive primary aldosteronism in 1972, almost 30 cases of normotensive primary aldosteronism have been reported in the English literature upto 2009. • Cases were predominantly Eurasian and Japanese (47% and 30%, respectively), middle-aged (range 23–60) and female (77%), suggesting that genetic and gender related protective factors play a role in the response to hyperaldosteronemia.

  7. The achievement and maintenance of ‘normal’ BP is a dynamic process that results from a dangerous sailing between vasoconstriction and vasodilatation (Figure 1).

  8. CONCLUSIONS • attention to the fact that PA is not confined to patients with grade II and III or resistant hypertension, but also occurs in patients with stage I hypertension and even in those with borderline elevated BP. • Interestingly, it took more than four decades to appreciate that, in addition to hypokalemia and hypertension, another classical hallmark of the PA syndrome could be absent or only subtly present in some patients.

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