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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Prevalence of unilateral hyperaldosteronism in primary aldosteronism: impact of a novel chemiluminescent immunoassay for measuring plasma aldosterone in Japan

Hypertension Research volume 47, pages 3035–3044 (2024)Cite this article

Abstract

This study aims to evaluate the prevalence of unilateral hyperaldosteronism (UHA) and its clinical characteristics in patients with primary aldosteronism (PA), diagnosed using plasma aldosterone concentration (PAC) measured by chemiluminescent enzyme immunoassay (CLEIA). We retrospectively analyzed data of 199 PA patients from the Japan Primary Aldosteronism Study II (JPAS II) dataset, including patients who underwent adrenal venous sampling (AVS) and the captopril challenge test (CCT) and/or saline infusion test (SIT), with PAC measured by CLEIA. We focused on two categories: confirmed PA, where patients exhibit clear biochemical evidence of the disorder, and borderline PA, where patients present with marginal biochemical indicators, as outlined in the Japan Endocrine Society’s clinical practice guideline for the diagnosis and management of PA. In confirmed PA cases, over the half of patients was UHA, while approximately 15 to 20% of borderline cases were found to be UHA. The prevalence of hypokalemia was identified as predictor of UHA among borderline cases. Among borderline cases with no hypokalemia and adrenal nodules on CT imaging, only 6 to 8% of patients were found to have UHA. Notably, some patients exhibited UHA despite negative results on one test but confirmed result on the other, particularly those with hypokalemia or adrenal nodules on CT imaging. In conclusion, the findings validate the importance of AVS in confirmed PA cases and the need for careful assessment in borderline cases. When feasible, conducting both CCT and SIT, and interpreting their results alongside other clinical indicators, could provide a more comprehensive assessment.

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Acknowledgements

We thank Daisuke Taura (Kyoto University), Kenji Oki (Hiroshima University), Yutaka Takahashi (Nara Medical University), Mika Tsuiki (National Hospital Organization Kyoto Medical Center), Minemori Watanabe (Okazaki City Hospital), Koichi Tamura (Yokohama City University) for collecting the clinical data, and Yuko Yasuda from the secretariat for her invaluable support and contributions.

JPAS II Study Group

Kenichi Yokota14, Masakatsu Sone14, Takuyuki Katabami6, Keiichiro Nakamae13, Mitsuhide Naruse13, Toshifumi Nakamura2, Akiyo Tanabe15, Daisuke Taura16, Yoshihiro Ogawa17, Koichi Yamamoto3, Takashi Yoneda9, Masanori Murakami11, Tetsuya Yamada11, Katsutoshi Takahashi8, Hiroki Kobayashi1, Takamasa Ichijo18, Norio Wada7, Kohei Kamemura19, Yuichi Fujii20, Yuichiro Yoshikawa21, Yasushi Miyazaki21, Shintaro Okamura22, Shigeatsu Hashimoto23, Minemori Watanabe24, Shoichiro Izawa4, Mika Tsuiki25, Hiromasa Goto26, Miki Kakutani27, Kouichi Tamura28, Nobuhito Hirawa29, Takehiro Kato30, Yutaka Takahashi31, Ryuji Okamoto10, Kazutoshi Miyashita32, Kihei Yoneyama33, Michio Otsuki34

Funding

JPAS and JRAS were supported by the research grant from the Japan Agency for Medical Research and Development (AMED) under Grant Number JP17ek0109122 and JP20ek0109352. This study was partly supported by a Grant-in-Aid from the Ministry of Health, Labour, and Welfare, Japan (No. 23FC0201 for research on intractable adrenal disorders).

Author information

Authors and Affiliations

  1. Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

    Hiroki Kobayashi, Yoshihiro Nakamura & Masanori Abe

  2. Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Toshifumi Nakamura

  3. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoichi Nozato & Koichi Yamamoto

  4. Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan

    Shoichiro Izawa

  5. Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan

    Miki Kakutani

  6. Department of Metabolism and Endocrinology, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan

    Takuyuki Katabami

  7. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan

    Norio Wada

  8. Division of Metabolism, Showa General Hospital, Tokyo, Japan

    Katsutoshi Takahashi

  9. Department of Health Promotion and Medicine of the Future, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan

    Takashi Yoneda

  10. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan

    Ryuji Okamoto

  11. Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Masanori Murakami & Tetsuya Yamada

  12. Department of Endocrinology, Tenri Hospital, Tenri, Japan

    Shintaro Okamura

  13. Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan

    Mitsuhide Naruse & Keiichiro Nakamae

  14. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Kenichi Yokota & Masakatsu Sone

  15. Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, Japan

    Akiyo Tanabe

  16. Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto, Japan

    Daisuke Taura

  17. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshihiro Ogawa

  18. Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

    Takamasa Ichijo

  19. Department of Cardiology, Shinko Hospital, Hyogo, Japan

    Kohei Kamemura

  20. Fujii Cardiovascular Internal Medicine, Hiroshima, Japan

    Yuichi Fujii

  21. Department of Endocrinology and Diabetes Mellitus, Misato Kenwa Hospital, Misato, Japan

    Yuichiro Yoshikawa & Yasushi Miyazaki

  22. Department of Endocrinology, Tenriyorozu Hospital, Nara, Japan

    Shintaro Okamura

  23. Department of Endocrinology, Metabolism, Diabetology and Nephrology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan

    Shigeatsu Hashimoto

  24. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan

    Minemori Watanabe

  25. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Mika Tsuiki

  26. Department of Metabolism and Endocrinology, Juntendo University Graduate School, Tokyo, Japan

    Hiromasa Goto

  27. Division of Diabetes, Endocrinology, and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    Miki Kakutani

  28. Division of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan

    Kouichi Tamura

  29. Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan

    Nobuhito Hirawa

  30. Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Gifu, Japan

    Takehiro Kato

  31. Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan

    Yutaka Takahashi

  32. Department of Internal Medicine, International University of Health and Welfare, Mita Hospital, Tokyo, Japan

    Kazutoshi Miyashita

  33. Denentoshi Hypertension Clinic Kanae, Yokohama, Japan

    Kihei Yoneyama

  34. Departments of Endocrinology, Tokyo Women’s Medical University, Tokyo, Japan

    Michio Otsuki

Authors
  1. Hiroki Kobayashi
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  2. Yoshihiro Nakamura
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  3. Masanori Abe
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  4. Toshifumi Nakamura
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  5. Yoichi Nozato
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  6. Shoichiro Izawa
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  7. Miki Kakutani
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  8. Takuyuki Katabami
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  9. Norio Wada
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  10. Katsutoshi Takahashi
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  11. Takashi Yoneda
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  12. Ryuji Okamoto
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  13. Masanori Murakami
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  14. Shintaro Okamura
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  15. Mitsuhide Naruse
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  16. Kenichi Yokota
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  17. Masakatsu Sone
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Consortia

JPAS II Study Group

  • Kenichi Yokota
  • , Masakatsu Sone
  • , Takuyuki Katabami
  • , Keiichiro Nakamae
  • , Mitsuhide Naruse
  • , Toshifumi Nakamura
  • , Akiyo Tanabe
  • , Daisuke Taura
  • , Yoshihiro Ogawa
  • , Koichi Yamamoto
  • , Takashi Yoneda
  • , Masanori Murakami
  • , Tetsuya Yamada
  • , Katsutoshi Takahashi
  • , Hiroki Kobayashi
  • , Takamasa Ichijo
  • , Norio Wada
  • , Kohei Kamemura
  • , Yuichi Fujii
  • , Yuichiro Yoshikawa
  • , Yasushi Miyazaki
  • , Shintaro Okamura
  • , Shigeatsu Hashimoto
  • , Minemori Watanabe
  • , Shoichiro Izawa
  • , Mika Tsuiki
  • , Hiromasa Goto
  • , Miki Kakutani
  • , Kouichi Tamura
  • , Nobuhito Hirawa
  • , Takehiro Kato
  • , Yutaka Takahashi
  • , Ryuji Okamoto
  • , Kazutoshi Miyashita
  • , Kihei Yoneyama
  •  & Michio Otsuki

Corresponding author

Correspondence to Hiroki Kobayashi.

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Kobayashi, H., Nakamura, Y., Abe, M. et al. Prevalence of unilateral hyperaldosteronism in primary aldosteronism: impact of a novel chemiluminescent immunoassay for measuring plasma aldosterone in Japan. Hypertens Res 47, 3035–3044 (2024). https://doi.org/10.1038/s41440-024-01786-5

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  • DOI: https://doi.org/10.1038/s41440-024-01786-5

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