Diagnosis and Treatment of Primary Aldosteronism: from Clinical Origin to Translational Research

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Background

Primary aldosteronism (PA) is a group of disorders in which aldosterone production is inappropriately high for sodium status, relatively autonomous for the major regulators of secretion, and non-suppressible by sodium loading. Previous studies report PA in > 5% and possibly >10% of hypertensive patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential hypertension. Mostly, a patient with PA needs to receive case detection, confirmation, and subtype classification before treatment. Despite the lack of standard procedure and unified cut-off value, adrenal venous sampling (AVS) has been recommended as a subtype classification. Currently, the guideline recommends unilateral laparoscopic adrenalectomy for patients with documented unilateral PA. In patients with PA due to bilateral adrenal disease, medical treatment with a mineralocorticoid receptor (MR) antagonist would be recommended.

Even though PA diagnosis and treatment are relatively mature, lots of questions remain to be addressed. In fact, some genes, such as KCNJ5, ATP1A1, and ATP2B3, play a vital role in the pathological process of PA. But the potential correlation between these mutated genes with subtypes, treatment, and prognosis of PA needs to be revealed. The mechanism by how high aldosterone level in PA impairs other organs and tissues need to be explained. In worldwide medical centers, both computed tomography (CT) and AVS are used to guide PA treatment. However, more well-designed randomized controlled trials should be conducted to address the real role of AVS. With rapidly developed radiology technology and increased biologic knowledge, can we find an alternative method to replace the invasive and expensive AVS? There are also debates on the choice between total adrenalectomy and partial adrenalectomy, with the widely used robotic-assisted surgery.

This Research Topic aims to cover, but is not limited to, the following areas:- The prevalence of PA in a general or specific population.- A potential new strategy to identify patients with subtle forms of dysregulated renin-independent aldosterone secretion.
• The pathogenesis of PA, in particular, bilateral hyperplasia (BAH) (or idiopathic hyperaldosteronism).
• The genetic and epigenetic basis for the hereditary syndromes of PA
• The role of aldosterone cell producing clusters in PA could be emphasized.
• Uniform therapeutic approach and long-term follow-up of cardiovascular and biochemical outcome parameters.
• Optimal surgical management of adrenal diseases.
• The current role of partial adrenalectomy for adrenal disease.
• Methods to select patients eligible for unilateral adrenalectomy.
• The outcomes after target treatments of PA- Long-term evaluation, especially quality of life in PA after target treatments.
• Should suspected adrenocortical carcinoma be addressed open or with minimally invasive surgical approaches?

We welcome observational studies, clinical trials, real-world studies, systematic reviews and meta-analysis, clinical practice guidelines, modeling studies, pharmaco-economic studies, drug resistance studies, bibliometric analysis, relevant research protocols and all the other article types that are generally accepted within the section Neuroendocrine Science.

*The Topic Editors would like to thank Wan-Chen Wu for her invaluable assistance in preparing this Research Topic.

Keywords: Primary Aldosteronism, Adrenal Venous Sampling, Diagnosis, Treatment

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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