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. 2009 May;106(18):305-11.
doi: 10.3238/arztebl.2009.0305. Epub 2009 May 1.

The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry

Caroline Schirpenbach  1 , Felix Segmiller, Sven Diederich, Stefanie Hahner, Reinhard Lorenz, Lars C Rump, Jochen Seufert, Marcus Quinkler, Martin Bidlingmaier, Felix Beuschlein, Stephan Endres, Martin Reincke
Affiliations

The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry

Caroline Schirpenbach et al. Dtsch Arztebl Int. 2009 May.

Abstract

Background: Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been standardized.

Methods: The authors retrospectively analyzed data of 555 patients (327 men and 228 women, aged 55 +/- 13 years) who were treated for primary hyperaldosteronism in 5 different centers from 1990 to 2006. The objective was to determine center-specific features of diagnosis and treatment.

Results: 353 (63%) of the patients had the hypokalemic variant of primary hyperaldosteronism; 202 never had documented hypokalemia. The centers differed markedly with respect to the patients' clinical presentation, diagnostic testing of endocrine function, and diagnostic imaging techniques, including adrenal venous sampling. The adrenalectomy rate ranged from 15% to 46%.

Conclusions: The registry data reveal an unexpected heterogeneity in the diagnostic evaluation and treatment of primary hyperaldosteronism. National or international guidelines are needed so that these can be standardized.

Keywords: Conn’s syndrome; aldosterone; hyperaldosteronism; hypertension; hypokalemia.

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Figures

Figure 1
Figure 1
Recommended diagnostic procedure in suspected primary hyperaldosteronism (according to 10) a) Screening for primary hyperaldosteronism and confirmation of diagnosis (according to 10). Because determination of plasma renin concentration (PRC) is now offered by most commercial laboratories and is simpler in the preanalytic phase (no storage on ice required before centrifugation in the laboratory), it is preferred to plasma renin activity (PRA). * Since there are various assays with relatively large differences in normal values for both PRC and plasma aldosterone concentration (PAC), it is crucial to heed the specifications (16, 21). Conversion factors: PAC: [ng/L]×2.775=[pmol/L]; PRC: [ng/L]×1.66=[mU/L]. b) Differential diagnosis and treatment of primary hyperaldosteronism. PAC, plasma aldosterone concentration
Figure 2
Figure 2
Age and sex distribution of the patients documented in the Conn Registry
Figure 3
Figure 3
Annual number of patients with primary hyperaldosteronism treated for the first time at the centers contributing data to the Conn Registry. Seven patients documented before 1990 are included in the total for 1990.
Figure 4
Figure 4
The dynamic tests used at the individual centers. The ordinate shows the proportion of patients at each center in whom the given test was performed. * Other dynamic tests: captopril test, fludrocortisone suppression test
Figure 5
Figure 5
Performance of imaging procedures and adrenal vein catheterization at the individual centers. The ordinate shows the proportion of patients at each center in whom the given procedure was performed. * AVC: Selective blood sampling by means of adrenal vein catheterization
See this image and copyright information in PMC

Comment in

  • Doubts.
    Sindermann J. Sindermann J. Dtsch Arztebl Int. 2009 Oct;106(42):692; author reply 692. doi: 10.3238/arztebl.2009.0692a. Epub 2009 Oct 16. Dtsch Arztebl Int. 2009. PMID: 19946439 Free PMC article. No abstract available.

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