Abstract
SS-1
PRIMARY ALDOSTERONISM IN KOREA JUNG HEE KIM Seoul National University College of Medicine
The first case of PA in Korea was reported in 1968. In the past, hypokalemia was considered to be a prerequisite, and less than 1% of all hypertensive patients were thought to be. However, several cross-sectional and prospective studies have reported prevalence of PA in more than 10% of hypertensive patients. There is no nationwide survey in Korea, but only about 30 cases were only diagnosed in Seoul National University Hospital (SNUH), and unilateral lesions were more dominant than bilateral ones. PA was still underdiagnosed in Korea. In keeping with recent genetic developments, we performed targeted gene sequencing in 66 patients with APA to detect somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D genes. Similar to other Asian countries, somatic KCNJ5 mutations were found in 47 (71.2%) of the 66 patients with APA (31 cases of p.G151R and 16 cases of p.L168R). Carriers of somatic KCNJ5 mutations were more likely to be female and young. The aldosterone-to-renin ratio (ARR) has been introduced as a screening test for PA, but a subtle change in low PRA exaggerates ARR, leading to misdiagnose low-renin hypertension as PA. In Korea, WKH VDOLQH LQIXVLRQ WHVW LV ZLGHO\ XVHG DV D FRQ¿UPDWRU\ WHVW IRU 3$ ZKLFK UHTXLUHV KRVSLWDOL]DWLRQ 7KH captopril challenge test (CCT) can easily performed in outpatient clinics, but the accuracy of it is still FRQWURYHUVLDO 7KHUHIRUH ZH DLPHG WR H[DPLQH WKH FOLQLFDO HI¿FDF\ RI &&7 DV D SRVW VFUHHQLQJ WHVW IRU PA in 64 subjects with suspected PA who had hypertension and ARR > 20. We suggested that subjects with PAC post-CCT at 90 min <13 ng/dL are less likely to have PA, and those with PAC post-CCT at PLQ EXW QJ G/ VKRXOG XQGHUJR VHFRQGDU\ FRQ¿UPDWRU\ WHVWV In PA, adrenal vein sampling (AVS) is recognized as a golden standard method of distinguishing XQLODWHUDO IURP ELODWHUDO GLVHDVHV +RZHYHU $96 LV LQYDVLYH WHFKQLFDOO\ GLI¿FXOW DQG RQO\ DYDLODEOH in several hospitals in Korea. Thus, we developed the clinical prediction parameters as a lateralization marker. Our new clinical prediction parameters included serum potassium, PAC after saline infusion test and unilateral nodule on CT (AUC = 0.779). Patients aged under 35 years with unilateral nodule on CT and hypokalemia may skip the AVS, which was suggested by the Guideline. In aldosterone-producing adenomas, hyperkalemia after adrenalectomy has been reported due to contralateral zona glomerulosa insufficiency. In SNUH, 13 of 124 patients (10.5%) developed postoperative hyperkalemia. Older age ( > 53 years), longer duration of hypertension ( > 9.5 years), larger mass size on CT ( > 1.95 cm), and impaired preoperative renal function (GFR < 58.2 ml/min) were associated with prolonged postoperative hyperkalemia in patients with APA. The mineralocorticoid receptor (MR) antagonist use did not prevent postoperative hyperkalemia. 87
