{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:08:50Z","timestamp":1776272930656,"version":"3.50.1"},"reference-count":44,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The past nine years have seen major advances in establishing the etiology of\n                    unilateral primary aldosteronism, and very possibly that of bilateral\n                    hyperaldosteronism, in response to somatic mutations in aldosterone synthase\n                    expressing cells. Though there have been important advances in the management of\n                    primary aldosteronism, in small but convincing studies, they represent minor\n                    changes to current guidelines. What has been totally absent is consideration of\n                    the public health issue that primary aldosterone represents, and the public\n                    policy issues that would be involved in addressing the disorder. In his\n                    introduction to PiPA 6, Martin Reincke calculated that only one in a thousand\n                    patients in Germany with primary aldosteronism were treated appropriately, an\n                    astounding figure for any disease in the 21st century. Towards remedying this\n                    totally unacceptable public health issue, the author proposes a radical\n                    simplification and streamlining of screening for primary aldosteronism, and the\n                    management of most patients by general practitioners. The second bottle-neck in\n                    current management is that of mandatory adrenal venous sampling for all but\n                    1\u20132% of patients, a costly procedure requiring rare expertise.\n                    Ideally, it should be reserved \u2013 on the basis of likelihood, enhanced\n                    imaging, or peripheral steroid profiles \u2013 for a small minority of\n                    patients with clear evidence for unilateral disease. Only when costs are\n                    minimized and roadblocks removed will primary aldosteronism be properly treated\n                    as the public health issue that it is.<\/jats:p>","DOI":"10.1055\/a-1120-8623","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T23:02:59Z","timestamp":1588633379000},"page":"459-466","source":"Crossref","is-referenced-by-count":13,"title":["Primary Aldosteronism: Where Are We Now? Where to from\n                    Here?"],"prefix":"10.1055","volume":"52","author":[{"given":"John Watson","family":"Funder","sequence":"additional","affiliation":[{"name":"Hudson Institute of Medical Research and Monash University, Clayton,\n                    Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,5,4]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1126\/science.1198785","article-title":"K+ channel mutations in adrenal aldosterone-producing adenomas and\n                    hereditary hypertension","volume":"331","author":"M Choi","year":"2011","journal-title":"Science"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1161\/HYPERTENSIONAHA.111.186478","article-title":"Prevalence, clinical, and molecular correlates of KCNJ5 mutations in primary\n                    aldosteronism","volume":"59","author":"S Boulkroun","year":"2012","journal-title":"Hypertension"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1161\/HYPERTENSIONAHA.111.186239","article-title":"Somatic mutations affecting the selectivity filter of KCNJ5 are frequent in 2\n                    large unselected collections of adrenal aldosteronomas","volume":"59","author":"E A Azizan","year":"2012","journal-title":"Hypertension"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"E819","DOI":"10.1210\/jc.2011-2965","article-title":"Microarray, qPCR, and KCNJ5 sequencing of aldosterone-producing adenomas reveal\n                    differences in genotype and phenotype between zona glomerulosa- and zona\n                    fasciculata-like tumors","volume":"97","author":"E A Azizan","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"E1567","DOI":"10.1210\/jc.2011-3132","article-title":"Effect of KCNJ5 mutations on gene expression in 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Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1440-1681.1992.tb00462.x","article-title":"Familial hyperaldosteronism type II: Five families with a new variety of primary\n                    aldosteronism","volume":"19","author":"M Stowasser","year":"1992","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1210\/jc.2011-2885","article-title":"Expression and mutations of KCNJ5 mRNA in Japanese patients with aldosterone\n                    producing adenomas","volume":"97","author":"R Taguchi","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1161\/HYPERTENSIONAHA.114.03346","article-title":"Clinical characteristics of somatic mutations in Chinese patients with\n                    aldosterone producing adenoma","volume":"65","author":"F F Zheng","year":"2015","journal-title":"Hypertension"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1038\/ng.2695","article-title":"Somatic and germline CACNA1D calcium channel mutations in\n                    aldosterone-producing adenomas and primary aldosteronism","volume":"45","author":"U I Scholl","year":"2013","journal-title":"Nat Genet"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"e06315","DOI":"10.7554\/eLife.06315","article-title":"Recurrent gain of function mutation in calcium channel CACNA1H causes\n                    early-onset hypertension with primary aldosteronism","volume":"4","author":"U I Scholl","year":"2015","journal-title":"Elife"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1038\/ng.2716","article-title":"Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype\n                    of adrenal hypertension","volume":"45","author":"E A Azizan","year":"2013","journal-title":"Nat Genet"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1038\/ng.2550","article-title":"Somatic mutations in ATP1A1 and ATP2B3 lead to aldosterone-producing adenomas\n                    and secondary hypertension","volume":"45","author":"F Beuschlein","year":"2013","journal-title":"Nat Genet"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"19546","DOI":"10.1038\/srep19546","article-title":"Activating mutations in CTNNB1 in aldosterone producing adenomas","volume":"6","author":"T \u00c5kerstr\u00f6m","year":"2016","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1038\/s41588-018-0048-5","article-title":"CLCN2 chloride channel mutations in familial hyperaldosteronism type II","volume":"50","author":"U I Scholl","year":"2018","journal-title":"Nat Genet"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/s41588-018-0053-8","article-title":"A gain-of-function mutation in the CLCN2 chloride channel gene causes primary\n                    aldosteronism","volume":"50","author":"F L Fernandes-Rosa","year":"2018","journal-title":"Nat Genet"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1161\/HYPERTENSIONAHA.119.14349","article-title":"Somatic CACNA1H mutation as a cause of aldosterone-producing adenoma","volume":"75","author":"K Nanba","year":"2020","journal-title":"Hypertension"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"3869","DOI":"10.1210\/jc.2018-01004","article-title":"Targeted molecular characterization of aldosterone-producing adenomas in white\n                    Americans","volume":"103","author":"K Nanba","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1161\/HYPERTENSIONAHA.118.12070","article-title":"Genetic Characteristics of aldosterone-producing adenomas in blacks","volume":"73","author":"K Nanba","year":"2019","journal-title":"Hypertension"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"E4591","DOI":"10.1073\/pnas.1505529112","article-title":"Aldosterone-stimulating somatic gene mutations are common in normal adrenal\n                    glands","volume":"112","author":"K Nishimoto","year":"2015","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1210\/js.2017-00134","article-title":"Aldosterone-producing cell clusters frequently harbor somatic mutations and\n                    accumulate with age in normal adrenals","volume":"1","author":"K Omata","year":"2017","journal-title":"J Endocr Soc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1161\/HYPERTENSIONAHA.118.11086","article-title":"Cellular and genetic causes of idiopathic hyperaldosteronism","volume":"72","author":"K Omata","year":"2018","journal-title":"Hypertension"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1210\/jc.2014-1153","article-title":"Seated saline suppression testing for the diagnosis of primary aldosteronism: A\n                    preliminary study","volume":"99","author":"A H Ahmed","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"4113","DOI":"10.1210\/jc.2018-01394","article-title":"Comparison of seated with recumbent saline suppression testing for the diagnosis\n                    of primary aldosteronism","volume":"103","author":"M Stowasser","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1111\/j.1365-2362.2011.02531.x","article-title":"High prevalence of autonomous aldosterone secretion among patients with\n                    essential hypertension","volume":"41","author":"A Gouli","year":"2011","journal-title":"Eur J Clin Invest"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1210\/jc.2015-1268","article-title":"Stress-induced aldosterone hyper-secretion in a substantial subset of patients\n                    with essential hypertension","volume":"100","author":"A Markou","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/BF01476798","article-title":"Evidence for a subgroup of essential hypertensives with non-suppressible\n                    excretion of aldosterone during sodium loading","volume":"58","author":"A Helber","year":"1980","journal-title":"Klin Wochenschr"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1161\/HYPERTENSIONAHA.116.08952","article-title":"Continuum of renin-independent aldosteronism in normotension","volume":"69","author":"R 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aldosteronism","volume":"45","author":"P Milliez","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1161\/HYPERTENSIONAHA.113.01060","article-title":"Cardiovascular complications associated with primary aldosteronism: a controlled\n                    cross-sectional study","volume":"62","author":"S Savard","year":"2013","journal-title":"Hypertension"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S2213-8587(17)30319-4","article-title":"Cardiovascular events and target organ damage in primary aldosteronism compared\n                    with essential hypertension: a systematic review and meta-analysis","volume":"6","author":"S Monticone","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"e15985","DOI":"10.1097\/MD.0000000000015985","article-title":"Cardiovascular risk in primary aldosteronism: A systematic review and\n                    meta-analysis","volume":"98","author":"X Wu","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1038\/s41440-019-0314-7","article-title":"Long-term phase 3 study of esaxerenone as mono or combination therapy with other\n                    antihypertensive drugs in patients with essential hypertension","volume":"42","author":"H Rakugi","year":"2019","journal-title":"Hypertens Res"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: Case detection diagnosis and treatment:\n                    an Endocrine Society clinical practice guideline","volume":"101","author":"J W Funder","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1210\/jc.2011-1537","article-title":"Evaluation of the sensitivity and specificity of (11)C-metomidate positron\n                    emission tomography (PET)-CT for lateralizing aldosterone secretion by\n                    Conn's adenomas","volume":"97","author":"T J Burton","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1210\/jc.2015-3431","article-title":"A Novel CYP11B2-Specific Imaging Agent for Detection of Unilateral Subtypes of\n                    Primary Aldosteronism","volume":"101","author":"T Abe","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1161\/HYPERTENSIONAHA.114.04453","article-title":"Measurement of peripheral plasma 18-oxocortisol can discriminate unilateral\n                    adenoma from bilateral diseases in patients with primary aldosteronism","volume":"65","author":"F Satoh","year":"2015","journal-title":"Hypertension"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1507\/endocrj.EJ11-0133","article-title":"Task Force Committee on Primary Aldosteronism, The Japan Endocrine Society.\n                    Guidelines for the diagnosis and treatment of primary aldosteronism--the Japan\n                    Endocrine Society 2009","volume":"58","author":"T Nishikawa","year":"2011","journal-title":"Endocr J"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1097\/HJH.0000000000001088","article-title":"Guidelines for primary aldosteronism: Uptake by primary care physicians in\n                    Europe","volume":"34","author":"P Mulatero","year":"2016","journal-title":"J Hypertens"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1161\/HYPERTENSIONAHA.119.12935","article-title":"Primary Aldosteronism","volume":"74","author":"J W Funder","year":"2019","journal-title":"Hypertension"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"15845","DOI":"10.1073\/pnas.0507358102","article-title":"The highly conserved cardiac glycoside binding site of Na,K-ATPase plays a role\n                    in blood pressure regulation","volume":"102","author":"I Dostanic-Larson","year":"2005","journal-title":"Proc Natl Acad Sci U S A"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1120-8623.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:35:51Z","timestamp":1661301351000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1120-8623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,4]]},"references-count":44,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2020,6,16]]},"published-print":{"date-parts":[[2020,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1120-8623","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,4]]}}}