Relapsed Primary Aldosteronism after Remission with Mineralocorticoid Receptor Antagonist Therapy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 723-757-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-746
Takashi Yoneda*, Masashi Oe, Mitsuhiro Kometani, Masashi Demura, Shigehiro Karashima, Shunsuke Mori, Atsushi Hashimoto, Toshitaka Sawamura, Rika Okuda, Masakazu Yamagishi and Yoshiyu Takeda
Kanazawa University, Kanazawa, Japan
(Context) There are several reports about remission of primary aldosteronism (PA) (J Endocrinol Invest 2005, Hypertension 2007, Clin Endocrinol 2011, JCEM 2012, Eur J Endocrinol. 2013). However, there has been no report about the evolution of PA with remission after the medical therapy. It is unclear whether the remission of PA may be maintained or not. We reported the remission of PA with mineralocorticoid receptor (MR) antagonists (spironolactone (SP) and eplerenone (EP)) in ENDO 2012.

 (Objective) We examined whether the relapse may occur among PA patients with remission after long-term MR antagonist therapy or not.

 (Methods) In the previous study, we defined complete remission (CR) of PA as normal aldosterone to renin ratio (ARR), normal suppression test, and normalization of hypokalemia without hypertension. Partial remission (PR) was defined as normal ARR, normal suppression test, and normalization of hypokalemia with hypertension. We identified 13 patients with remission. SP produced CR in one patient with APA, two with IHA, and two with subtype unknown and produced PR in three with IHA and one with subtype unknown. EP produced only PR in two with IHA and two with subtype unknown. In present study, five patients with CR were not treated. Eight PR patients were treated with calcium channel blocker (CCB) or/and α1-blocker. Every 3 months, blood pressure, biochemical parameters and ARR were measured. If high ARR (>200) or hypokalemia (<4.0 mEq/L) was observed, suppression tests such as captopril challenging test, furosemide plus upright posture test, or saline loading test was performed as confirmatory test for PA. Relapse of PA was defined as hypokalemia, high ARR or abnormal result in any of suppression tests.

(Results)We identified 3 of 13 (23%) patients with relapse: two IHA patients treated with SP and one IHA patient treated with EP. Two relapses occurred nine months and fifteen months after the cessation of SP treatment. One relapse occurred in tweleve months after the cessation of EP treatment.

(Conclusion)Relapse may occur in some PA patients after remission with long-term MR treatment.

Nothing to Disclose: TY, MO, MK, MD, SK, SM, AH, TS, RO, MY, YT

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