Primary hyperaldesteronism
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Primary hyperaldosteronism is caused by overproduction of the hormone aldosterone from one or both adrenal glands, leading to elevated blood pressure. Primary hyperaldosteronism is the most common form of secondary hypertension, meaning elevated blood pressure with an underlying cause. The estimated prevalence is 5-15% of all people with hypertension. Untreated primary hyperaldosteronism carries a higher risk of cardiovascular and kidney complications than primary hypertension. Therefore, it is very important to get a correct diagnosis to receive the best possible treatment that both lowers blood pressure and reduces the risk of complications. However, many cases remain undetected. If aldosterone overproduction from one adrenal gland is detected, traditional surgical removal of the affected adrenal gland is recommended, while lifelong treatment with specific blood pressure medications, mineralocorticoid receptor antagonists, which inhibit the action of aldosterone in the body, is recommended for aldosterone overproduction from both adrenal glands.
Current research projects:
Diagnosis and follow-up of primary hyperaldosteronism
This is an observational study that has included patients with primary hyperaldosteronism who are being investigated at Haukeland University Hospital since 2013. Today's investigation of primary hyperaldosteronism is resource-intensive and consists of many steps, often with medication adjustments beforehand. The study maps the prevalence, symptoms, and findings at the time of diagnosis, as well as the results of investigation and treatment. The aim of the study is to systematize, simplify, and improve diagnostics, and provide even better treatment for PHA. We are working to expand the study to include patients with primary hyperaldosteronism who are being investigated at Oslo University Hospital.
The study has so far shown that untreated primary hyperaldosteronism leads to thickened left heart muscle (left ventricular hypertrophy) in both women and men; Preclinical cardiac disease in women and men with primary aldosteronism - PubMed. The study has also shown that correct specific treatment of primary hyperaldosteronism leads to rapid improvement of thickened heart muscle and other heart damage, especially after adrenal surgery, but also with adequate doses of medical treatment. Cardiac magnetic resonance imaging of myocardial mass and fibrosis in primary aldosteronism - PubMed. Persistent cardiac organ damage in surgically and medically treated primary aldosteronism - PubMed.
Results from the project are also included in international publications for improved interpretation of the investigation procedure adrenal venous catheterization, Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism - PubMed, as well as in an expected imminent publication that maps differences in time from the start of investigation to the time of adrenal surgery among centers around the world.
Aldosterone rhythm in primary hyperaldosteronism (ULTRADIAN study)
Hormones are secreted in a rhythmic pattern, with large variations in hormone levels throughout the day. Disturbances in the secretion of aldosterone and other adrenal hormones can therefore be difficult to detect in a single blood or urine sample. In this pilot study, we have used new microdialysis technology to measure levels of adrenal hormones in subcutaneous fluid throughout the day. The purpose of the study is to increase knowledge about variations in aldosterone and other adrenal hormones' rhythmic secretion throughout the day, both in healthy individuals and in patients with primary hyperaldosteronism. This knowledge can then be used to improve diagnostics in primary hyperaldosteronism and to map treatment effects after adrenal surgery. Results from healthy controls were published in 2023; High-resolution daily profiles of tissue adrenal steroids by portable automated collection - PubMed. Results from individuals with primary hyperaldosteronism have been analyzed and are expected to be published in 2025.
Dynamic hormone profiling and multimodal data capture in primary hyperaldosteronism
This is a continuation of the ULTRADIAN study, where microdialysis technology is used to measure 24-hour hormone rhythms in tissue fluid from subcutaneous fat on the abdomen in primary hyperaldosteronism. 24-hour microdialysis can be performed in this study during diagnostic saline testing or medication use to increase knowledge about how these affect hormone rhythms. In the study, we will also map the relationship between hormone rhythms and blood pressure levels, pulse, tissue glucose, body temperature, sleep, and activity level. The study started in 2024.
Treatment with endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) compared to adrenal surgery in primary hyperaldosteronism
This is a pilot treatment study conducted at Haukeland University Hospital, where we are testing a completely new type of treatment with endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of a lesion in the left adrenal gland, as an alternative to standard surgical treatment with removal of the entire left adrenal gland. This treatment is relevant for individuals with primary hyperaldosteronism where adrenal venous catheterization has shown lateralization of aldosterone overproduction to the left adrenal gland, as an alternative to surgery of the entire left adrenal gland. In some cases, we will also offer participation in the study to individuals where aldosterone overproduction is not clearly confined to the left adrenal gland, but where we expect that radiofrequency ablation treatment can reduce hormone overproduction and improve blood pressure. The study is conducted in close collaboration with gastroenterologists (gastrointestinal specialists) and adrenal surgeons at Haukeland University Hospital.
Contact information for all projects:
Marianne Grytaas, Chief Physician PhD
