Diagnosing variable primary aldosteronism.
Research type
Research Study
Full title
Do we miss a common subset of Primary Aldosteronism in which there is cyclical or exaggerated diurnal variation in secretion?
IRAS ID
318689
Contact name
William Drake
Contact email
Sponsor organisation
Queen Mary University of London
Clinicaltrials.gov Identifier
Duration of Study in the UK
3 years, 0 months, 0 days
Research summary
Hypertension(high blood pressure) causes heart attacks and strokes. Most people with hypertension have ‘essential’ hypertension, in which no underlying cause is identified. Approximately 10% of people with hypertension have primary aldosteronism(PA) – a condition in which the body inappropriately retains salt(sodium), due to excess production of the hormone aldosterone, produced by one or both of two adrenal glands that sit on top of the kidneys in the abdomen. Identifying people with PA is important. In selected patients, it is possible to identify one adrenal gland as the source of the problem and remove it surgically. In those unsuitable for surgery, available medications are effective, but rarely prescribed because only 1% of patients with PA are ever diagnosed.
We need better ways of detecting PA and selecting those most likely to benefit from surgery. We aim to address both of these. The current screening method for detecting PA is a ‘snapshot’ blood test. We believe that some people are not being diagnosed because their aldosterone secretion fluctuates throughout the day and that measuring the amount of aldosterone excreted by the kidneys into urine over 24 hours could identify these patients.
Certain mutations (genetic ‘spelling mistakes’) in the adrenal gland affect the rhythm with which aldosterone is produced and may cause variable aldosterone production throughout the day. Patients with these mutations in ‘clock’ genes (influenced by the body’s daily rhythm) have been observed to be completely cured of hypertension by adrenal surgery.
This project aims to identify the cohort of patients that may have ‘missed’ the diagnosis of PA due to a variable secretion of aldosterone. We will do this by studying their 24-hour urine samples. If diagnosed with PA and found to have unilateral disease, we also investigate, if this subset of patients are likely to have complete cure following adrenalectomy.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
22/PR/1374
Date of REC Opinion
4 Jan 2023
REC opinion
Further Information Favourable Opinion