{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:26:01Z","timestamp":1769905561221,"version":"3.49.0"},"reference-count":24,"publisher":"The Endocrine Society","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Primary hyperaldosteronism is characterized by high plasma and urinary aldosterone and suppressed PRA. Renin suppression is due to aldosterone-dependent sodium retention and mild extracellular volume expansion. We observed three patients with primary hyperaldosteronism, severe refractory hypertension, and normal to high normal PRA levels whose aldosterone\/renin ratios were still elevated because of disproportionately high aldosterone levels. All available medical data on the patients as well as publications on the aldosterone\/renin relationship in primary hyperaldosteronism were reviewed to explain the unusual findings.<\/jats:p>\n               <jats:p>In one patient, histologically proven renal arteriolosclerosis was the probable cause of the escape of PRA from suppression by an aldosterone-producing adenoma. In the other two patients, hypertensive kidney damage due to primary hyperaldosteronism was the most likely explanation for the inappropriately high PRA, as in patient 1. All patients had high normal or slightly elevated serum creatinine levels and responded to 200 mg spironolactone\/day with increased serum creatinine and hyperkalemia. Hyperkalemia was probably due to a decreased filtered load of sodium and a spironolactone-induced decrease in mineralocorticoid function. Two patients were cured of hyperaldosteronism by unilateral adrenalectomy but still need some antihypertensive therapy, whereas one patient has probable bilateral adrenal disease, with normal blood pressure on a low dose of spironolactone.<\/jats:p>\n               <jats:p>In patients with severe hypertension due to primary hyperaldosteronism, PRA can escape suppression if hypertensive kidney damage supervenes. An increased aldosterone\/PRA ratio is still useful in screening for primary hyperaldosteronism. These patients may respond to spironolactone therapy with a strong increase in serum creatinine and potassium. Early specific treatment of primary hyperaldosteronism is therefore indicated, and even a patient with advanced hypertension will profit from adrenalectomy or cautious spironolactone treatment.<\/jats:p>","DOI":"10.1210\/jcem.85.9.6819","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T17:06:07Z","timestamp":1389200767000},"page":"3266-3270","source":"Crossref","is-referenced-by-count":25,"title":["Primary Hyperaldosteronism without Suppressed Renin Due to Secondary Hypertensive Kidney Damage"],"prefix":"10.1210","volume":"85","author":[{"given":"W.","family":"Oelkers","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Klinikum Benjamin Franklin, Freie Universita\u0308t Berlin, 12200 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Diederich","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Klinikum Benjamin Franklin, Freie Universita\u0308t Berlin, 12200 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Ba\u0308hr","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Klinikum Benjamin Franklin, Freie Universita\u0308t Berlin, 12200 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","reference":[{"key":"2020071614013168700_R1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1365-2265.1996.tb02059.x","article-title":"Primary hyperaldosteronism. I. Diagnosis of primary hyperaldosteronism.","volume":"45","year":"1996","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2020071614013168700_R2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S0889-8529(05)70283-8","article-title":"Pheochromocytoma and primary hyperaldosteronism: diagnostic approaches.","volume":"26","year":"1997","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2020071614013168700_R3","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1056\/NEJM199812173392507","article-title":"Primary hyperaldosteronism.","volume":"339","year":"1998","journal-title":"N Engl J Med"},{"key":"2020071614013168700_R4","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(98)06102-9","article-title":"Mineralocorticoid hypertension.","volume":"353","year":"1999","journal-title":"Lancet"},{"key":"2020071614013168700_R5","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1210\/jcem-52-5-1009","article-title":"Normotensive primary hyperaldosteronism: report of a case.","volume":"52","author":"Kono","year":"1981","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071614013168700_R6","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S0140-6736(81)90709-1","article-title":"The diagnosis of primary hyperaldosteronism.","volume":"1","author":"Vaughan","year":"1981","journal-title":"Lancet"},{"key":"2020071614013168700_R7","article-title":"Advances in diagnosis and therapy of primary hyperaldosteronism. In: Christiansen C, Riis BJ, eds","author":"Oelkers","year":"1987"},{"key":"2020071614013168700_R8","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/j.1440-1681.1992.tb00457.x","article-title":"Concurrence of primary aldosteronism and renal artery stenosis.","volume":"19","author":"Stokes","year":"1992","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"2020071614013168700_R9","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1093\/ndt\/12.12.2735","article-title":"Coexisting renal artery stenosis and primary aldosteronism.","volume":"12","author":"Chowdhury","year":"1997","journal-title":"Nephrol Dial Transplant"},{"key":"2020071614013168700_R10","article-title":"Nephron heterogeneity with unsuppressible renin secretion: s cause of essential hypertension. In: Laragh JH, Brenner BM, eds. Hypertension: pathophysiology, diagnosis, and management, 2nd Ed","author":"Sealey","year":"1995"},{"key":"2020071614013168700_R11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/0039-128X(96)00007-4","article-title":"Effects of estrogens and progestogens on the renin-aldosterone system and blood pressure.","volume":"61","year":"1996","journal-title":"Steroids"},{"key":"2020071614013168700_R12","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2169\/internalmedicine.36.700","article-title":"Malignant hypertension in a patient with primary aldosteronism with elevated renin concentration.","volume":"36","author":"Oka","year":"1997","journal-title":"Intern Med"},{"key":"2020071614013168700_R13","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/0002-9343(83)91022-7","article-title":"The changing clinical spectrum of primary aldosteronism.","volume":"74","author":"Bravo","year":"1983","journal-title":"Am J Med"},{"key":"2020071614013168700_R14","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/0002-9610(64)90252-1","article-title":"Clinical characteristics of primary aldosteronism from an analysis of 145 cases.","volume":"107","author":"Conn","year":"1964","journal-title":"Am J Surg"},{"key":"2020071614013168700_R15","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0002-9343(73)90128-9","article-title":"Vasoconstriction\u2013volume analysis for understanding and treating hypertension: the use of renin and aldosterone profiles.","volume":"55","year":"1973","journal-title":"Am J Med"},{"key":"2020071614013168700_R16","first-page":"401","article-title":"Renal abnormalities and vascular complications in primary hyperaldosteronism. Evidence on tertiary hyperaldosteronism.","volume":"45","author":"Beevers","year":"1976","journal-title":"Q J Med"},{"key":"2020071614013168700_R17","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/BF03347840","article-title":"Vascular complications in patients with aldosterone producing adenoma in Japan.","volume":"18","author":"Takeda","year":"1995","journal-title":"J Endocrinol Invest"},{"key":"2020071614013168700_R18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0272-6386(99)70298-2","article-title":"Cardiovascular complications in patients with primary hyperaldosteronism.","volume":"33","author":"Nishimura","year":"1999","journal-title":"Am J Kidney Dis"},{"key":"2020071614013168700_R19","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1001\/archinte.1981.00340130033011","article-title":"A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity.","volume":"141","author":"Hiramatsu","year":"1981","journal-title":"Arch Intern Med"},{"key":"2020071614013168700_R20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/j.1440-1681.1994.tb02519.x","article-title":"High incidence of primary hyperaldosteronism in 199 patients referred with hypertension.","volume":"21","author":"Gordon","year":"1994","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"2020071614013168700_R21","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0140-6736(05)74868-6","article-title":"Potentially high prevalence of primary aldosteronism in a primary care population.","volume":"353","author":"Lim","year":"1999","journal-title":"Lancet"},{"key":"2020071614013168700_R22","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1210\/jcem-26-5-553","article-title":"Postoperative studies of adrenal function in primary hyperaldosteronism.","volume":"26","author":"Biglieri","year":"1966","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071614013168700_R23","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure.","volume":"341","author":"Pitt","year":"1999","journal-title":"N Engl J Med"},{"key":"2020071614013168700_R24","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/ajh\/4.9.786","article-title":"Reassessment of the prediction value of the postural stimulation test in primary.","volume":"4","author":"Fontes","year":"1991","journal-title":"Hyperaldosteronism Am J Hypertens"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/85\/9\/3266\/9061511\/jcem3266.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/85\/9\/3266\/9061511\/jcem3266.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T01:12:37Z","timestamp":1594948357000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/85\/9\/3266\/2660606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,9,1]]},"references-count":24,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2000,9,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jcem.85.9.6819","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,9,1]]}}}