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Renal Insufficiency

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Female Urogenital Diseases and Pregnancy Complications

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Water-Electrolyte Imbalance

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All Drugs and Chemicals

Channel Blockers

Diuretics

Sodium Channel Blockers

Diuretics, Potassium Sparing

Mineralocorticoid Receptor Antagonists

Mineralocorticoids

Patients treated with mineralocorticoid antagonists or potassium sparing diuretics for primary aldosteronism

Unilateral adrenalectomy in patients with unilateral disease

Troy Puar, MRCP

Troy Puar

Majority of patients with hypertension have primary hypertension (without an underlying cause). Primary aldosteronism (PA) is the most common cause of secondary hypertension, and can be found in 5-10% of patients locally. PA is caused by excessive release of a hormone (aldosterone) from the adrenal glands, which can be unilateral (one gland) or bilateral (both glands).

It has been shown that excess aldosterone has other harmful effects in addition to hypertension, such as directly affecting the heart, blood vessels, kidneys, leading to increased cardiovascular morbidity and mortality. This is supported by studies showing reversal of these effects after treatment for PA.

The investigators aim to assess the long-term cardiovascular, and renal outcomes of patients with PA, compared to patients with essential hypertension.

Outcome of Patients With Primary Aldosteronism

Long-term Outcomes in Patients With Primary Aldosteronism After Treatment

incidence of new cardiovascular events including acute myocardial infarction, revascularisation percutaneously, coronary artery bypass graft, stroke, admission for congestive cardiac failure, atrial fibrillation

incidence of worsening chronic kidney disease, decline of glomerular filtration rate by 15ml/min from at least 60m/min

rate of decline of glomerular filtration rate

Identify variables that are more common in patients with unilateral disease

Identify variables that are more common in patients with positive blood pressure response

Singapore General Hospital

Changi General Hospital

Vasoconstrictor Agents

Respiratory System Agents

Natriuretic Agents

Antihypertensive Agents

Epinephrine

Amiloride

Spironolactone

Racepinephrine

Epinephryl borate

Eplerenone

Hormones

Hormone Antagonists

Patients who undergo medical treatment, in view of bilateral PA, or unilateral PA not keen for surgery, or indeterminate (lack of localisation on tests)

Patients with unilateral PA who underwent adrenalectomy

Adrenalectomy for unilateral adrenal hyperplasia / adenoma

Adrenalectomy

Troy Puar, MRCP (UK)

Majority of patients with hypertension have primary hypertension (without an underlying cause). Secondary hypertension (due to an underlying disease) is important to recognize, as treatment can lead to cure of hypertension. Primary aldosteronism (PA) is the most common cause of secondary hypertension, and can be found in 5-10% of patients locally.

PA is caused by excessive release of a hormone (aldosterone) from the adrenal glands, which can be unilateral (one gland) or bilateral (both glands). Distinction between two is crucial as unilateral disease is treated with the aim of cure by surgery, and bilateral disease is treated by medication.

It has been shown that excess aldosterone has other harmful effects in addition to hypertension, such as directly affecting the heart, blood vessels, kidneys, diabetes and quality of life. This is supported by studies showing reversal of these effects after treatment for PA. In addition, improvements after surgery appears to be superior to medical treatment, although studies have found variable results.

Hence, the investigators aim to accurately subtype patients with PA into unilateral or bilateral disease and study the post-treatment response after both surgery and medicine with regards to the effects on blood pressure, cardiovascular, renal, metabolic and quality of life.

Peripheral blood samples Adrenal vein blood samples (during adrenal vein sampling) Adrenal tissue (post-adrenalectomy)

Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism

Prospective Study Assessing Blood Pressure, Cardiovascular, Endothelial and Other Outcomes poSt-surgical and Medical Treatment in Patients With Primary Aldosteronism

Blood pressure assessed by 24hr ambulatory BP

Use of antihypertension medications as expressed in daily defined dosages and total number of medications

change in serum creatinine, calculated GFR, albuminuria (prevalence and severity)

Proportion of patients reaching normal BP (ambulatory /home BP \<135/85 or clinic BP \<140/90)

Proportion of patients with cure of PA after adrenalectomy

Carcinoma

Cushing Syndrome

Adrenocortical Adenoma

Adrenocortical Carcinoma

Adenocarcinoma

Adrenal Cortex Neoplasms

Adrenal Gland Neoplasms

Endocrine Gland Neoplasms

Adrenal Cortex Diseases

Cushing's Syndrome

Adenoma of the Adrenal Gland

Nodular Regenerative Hyperplasia

15 patients were investigated with PET/CT after injection of 2,5 MBq/kg \[18F\]CETO. 5 healthy volunteers were investigated twice (Test-retest), with approximately 2 weeks in-between each PET/CT investigation, after injection of 1,3 MBq/kg \[18F\]CETO. Arterial blood samples were taken as well as urinary sampels.

3 out of 5 healthy volunteers were also investigated twice with PET/CT after injection of 13,2 MBq/kg \[15O\]water, performed before the \[18F\]CETO PET/CT.

Injection of F18CETO or O15water followed by PET/CT

F18CETO

Per Hellman, Professor

Purpose of this clinical phase 1 trial was to determine if para-chloro-2-\[18F\]fluoroethyletomidate positron emission computed tomography (\[18F\]CETO-positron emission computed tomography(PET)/computed tomography(CT)) can be used in diagnostics of adrenal tumors and if the biochemical/pharmacological states conditions in humans with various illnesses, compared to healthy humans, such as the radio tracer is suitable?

After receiving oral and written information about the study and its potential risks, all participants provided written informed consent. All participants underwent a screening visit 1-28 days before their \[18F\]CETO PET/CT. At the screening visit their medical history was obtained, including besides information of previous disease(s) and medication, also a clinical examination, WHO performance status, height, weight, pulse rate and blood pressure, blood chemistry and haematology.

Right before the PET/CT investigation a baseline assessment was performed including:

* A physical examination according to Modified Early Warning Score (MEWS)
* 12-lead electrocardiogram (ECG)
* Any concomitant medications was recorded
* Medical history - occurrence of any new symptoms and events since the screening visit
* Hematology (International Normalized Ratio (INR) in patients with antiocoagulant treatment).
* Pregnancy test in women.
* Assessment of injection site monitored by visual inspection (rash and phlebitis)

Participants received on average 0,76 mikrograms (range 0,1-1.37 mikrograms) of administered mass of CETO in conjunction to the PET/CT investigation.

Potential adverse events were monitored closely during, and after the administration of \[18F\]CETO, with access to emergency medicine resources.

Each participant remained for observation at least 3 hours after administration of \[18F\]CETO and the following assessments were performed:

* Blood withdrawn for additional post-scan chemical analysis.
* Assessment of injection site monitored by visual inspection (rash and phlebitis).
* MEWS

The ten first participants were evaluated for serious adverse events/adverse events (SAE/AEs) the day after (approximately 24 hours after) performing the \[18F\]CETO PET due to the short half-life of the radionuclide used, fluorine- 18 (T1/2= 109.5 min). Safety reporting was assessed by use of clinical Adverse Events and Common Toxicity Criteria (CTC), laboratory and non-laboratory toxicities.

First-in-human Evaluation of [18F]CETO

Studies of 18F-CETO as a Tracer for Adrenal PET Diagnostics

Number of patients with treatment-related adverse events as assessed by clinical Adverse Events and Common ToxicityNCI Common Terminology Criteria for Adverse Events v4.0 (CTCAE)

Arterial blood was collected to determined the fraction of intact \[18F\]CETO in plasma. PET- modelling based on dynamic PET-data and metabolite analysis was performed for scientific purposes. Measurement of Standard Uptake Value (SUV) was determined for the adrenal glands.

Measurement of SUV for organs was determined.

Difference in SUV in the adrenal glands between two investigations in the samt participant was determined.

Uppsala University Hospital

British Medical Research Council

Uppsala University

Histopathology shows a clear boundary between adrenal adenoma and surrounding normal tissue.

Histopathology shows no clear boundary between adrenal hyperplasia and surrounding normal tissues.

There is a clear boundary between adrenal adenoma and surrounding normal tissue. There is no clear boundary between adrenal hyperplasia and surrounding normal tissues.

histopathology

Yan Zhencheng, MD

Zhencheng Yan, MD

Primary aldosteronism (PA) is a common cause of secondary hypertension, which is characterized by excessive aldosterone production by the adrenal gland. Excessive aldosterone can significantly increase the risk of cardiovascular disease and stroke. Patients with aldosterone-producing adenoma (APA) or unilateral hyperplasia (UAH) can be cured by unilateral adrenalectomy. The adrenal cortex is the outer part of the adrenal gland and is subdivided into three layers- the zona glomerulosa, the zona fasciculata, and the zona reticularis. And the outermost layer is the zona glomerulosa, and it's full of cells that make the hormone aldosterone. Although it has been investigated that the main cause of APA or UAH is the mutations of different calcium ion channels, including KCNJ5, CACNA1D, CLCN2 et al, it is still unknown whether there are any other changes of other proteins in different layers. Therefore, the investigators designed the study to characterize the proteomics profiles of adrenal adenoma/hyperplasia leading to primary aldosterone and identify biomarkers for early identification of PA by using spatial proteomics. The samples from adrenal adenoma or hyperplasia will be collected and analyzed by spatial proteomics in Hangzhou Jingjie Biotechnology Co., Ltd. The differentially expressed proteins in different layers will be screened out between APA and UAH, APA and its adjacent normal tissues, and UAH and its adjacent normal tissues, respectively. And KEGG analysis will be conducted to determine enriched pathway in these differentially expressed protein, respectively.

Samples of adrenal collected from aldosterone-producing adenoma and unilateral hyperplasia by operation.

Spatial Proteomics Profiles of Aldosterone-producing Adenoma and Unilateral Hyperplasia

Spatial Proteomics Profiles of Adrenal Adenoma/Hyperplasia Leading to Primary Aldosterone

Histological validation of the CYP11B2 positive area in APA and UAH by immunohistochemical staining (IHC). Some specimens will be characterized more deeply with advanced spatial proteomics technologies to identify the biomarkers.

Verifying the relationship between biomarkers and clinical presentations, including plasma aldosterone concentrations (PAC), aldosterone to rein ratio (ARR), direct renin concentration (DRC), and serum potassium, etc. Comparing the relationships between biomarkers and risk factors, including osas and family history, etc. Establishing a mathematical model for diagnosing PA through machine learning and studying the pathogenesis of PA through corresponding animal models.

The alteration of blood pressure and medication status are investigated through 3 months followed up. Verifying the relationship between the biomarkers and the function of APA and UAH, as well as the prognosis of PA.

Third Military Medical University

professor

Anti-Inflammatory Agents

Dermatologic Agents

Hydrocortisone

Hydrocortisone 17-butyrate 21-propionate

Hydrocortisone acetate

Hydrocortisone hemisuccinate

Hydrocortisone-17-butyrate

AAVS performed with no intraprocedural rapid cortisol assay

AVS performed plus intraprocedural rapid cortisol assay

AVS performed with no intraprocedural rapid cortisol assay

Adrenal vein sampling performed according to usual clinical practice without intraprocedural rapid cortisol assay

Background: Adrenal vein sampling (AVS) is the gold standard test for the subtyping of primary aldosteronism (PA). This procedure is hampered by unsuccessful bilateral cannulation of adrenal veins, which can occur in up to two thirds of the cases depending on the cutoff of the selectivity index used. The rapid intra-procedural cortisol assay (IRCA) can increase the rate of bilateral success of AVS. This can be proven using a randomized prospective study design approach.

Aim: We will therefore evaluate if an IRCA-guided AVS strategy can increase the rate of selectivity and thus the success rate of adrenal vein catheterization.

Methods: Consecutive patients with a biochemical diagnosis of PA, seeking surgical cure, will be randomized to undergo AVS according to an IRCA-sham or an IRCA-guided procedure.

Experimental and endpoint will be the rate of bilaterally selective AVS studies as defined by a selective index cutoff \> 2.00 value under baseline (unstimulated) conditions. With 100 patients submitted to AVS with a normal procedure and 100 patients undergoing AVS with IRCA, it has been estimated that the study has 82% power to detect a significant difference of 18% at a two-sided 0.05 significance level between arms.

Expected results. Given this power we expect to the able to determine if IRCA is useful or not for improving the success rate of AVS. Given the current disastrous situation regarding the clinical use of AVS this will be a major accomplishment in the field of the subtyping of PA.

Primary aldosteronism (PA) is a common form of hypertension caused by excess aldosterone secretion: it involves over 11% of the patients referred to specialized hypertension centres \[1\], about one fifth of those with drug-resistant hypertension \[2\] and about 6% of the hypertensive patients seen in general practice \[3\].

PA is held to cause cardiovascular disease in excess of the degree of blood pressure elevation, which translates into a high rate of cardiovascular events. These ominous consequences can be prevented with a timely diagnosis. Once the diagnosis of PA has been made, the decision to proceed further with surgical or medical treatment depends on identification of the PA subtype. In fact, adrenalectomy, can be necessary in up to two thirds of the PA cases \[1\], and was shown to regress cardiovascular damage and prevent CV events at long-term \[4\]. Therefore, identification of PA followed by subtyping entails fundamental steps that can be particularly beneficial in some subgroups of patients as those with drug-resistant hypertension, who are at high cardiovascular risk of PA \[2\].

Adrenalectomy is indicated only once a lateralized aldosterone excess has been identified by adrenal vein sampling (AVS). This is a technically challenging procedure because placing the catheter's tip within the tiny and short right adrenal vein is difficult. Samples are, therefore, often obtained from at or near the orifice of the vein, which can lead to dilution of the adrenal hormones, and thus to non selective studies. Unfortunately, accomplishment bilateral selectivity was disappointingly low, particularly if high cutoff values of the selectivity index are used, as shown by the largest study ever performed worldwide. To overcome this limitation several methods have recently been proposed, including stimulation with cosyntropin or metoclopramide \[5-10\], use of alternative biomarkers, as for example, plasma metanephrines or androstenedione that have a step-up between adrenal vein and inferior vena cava (IVC) higher than cortisol \[11\], and the intra-procedural rapid cortisol assay (IRCA). The latter can improve the success rate of AVS, particularly at a stage when radiologists are gaining experience with the procedure. Accordingly, several centres have adopted this practice after its introduction \[12\] and reported anecdotal successes, but logistic problems have prevented widespread use of IRCA in clinical practice \[13\].

Recently a kit for the semi-quantitative IRCA has been developed \[14\], which lends itself to routine clinical use owing to its simplicity, ease, and speed of use. Yet, the advantages of exploiting an IRCA-based strategy for improving the success rate in achieving selectivity of AVS has been proven only in one randomized clinical trial (RCT) carried out in Japan, which involved 7 centres, most of which had no or, a limited experience with AVS \[14\].

RTCs represent the basis for evidence-based and high-grade class of recommendations in practice guidelines. Therefore, we plan to test the hypothesis that the IRCA during AVS could improve the rate of bilaterally selective AVS studies over that accomplished by a routine AVS protocol even when used at referral centres that routinely perform this diagnostic procedure.

Methods Consecutive patients with biochemical diagnosis of PA seeking surgical cure of PA will be recruited for this study, according to current guidelines \[15\]. These patients have a compelling indication to AVS before being referred or not for adrenalectomy \[9\]. The only exclusion criteria will be: a) refusal of the centre to participate in the study; b) refusal of the patient to undergo AVS , c) contraindications to the general anaesthesia that is required for laparoscopic adrenalectomy; d) cortisol co-secreting adenoma. The latter criterion is necessary because, given the cortisol-derived selectivity index (see below) primary endpoint chosen, inclusion of these tumours would introduce an obvious confounding bias on results \[16\].

Study design The outlay of this prospective randomized two-arm multicentre study, and its primary endpoint are summarized below. Randomization will be performed with a specific algorithm as provided in a the SPSSS statistical package. The study will last until 220 patients will be recruited and randomly assigned to either arm considering the possibility of a 10% dropout rate. Data collection will be performed by means of a specific form created ad hoc for the AVIS Study and modified as required \[17\]. The assignment to either arm will be coded and the data analysis for the primary end-point will be performed by investigators blindly to arm assignment.

In the IRCA arm, the plasma obtained simultaneously from each adrenal vein and the IVC will be tested with typical cortisol assay and in case of non selective results catheters will be repositioned until selective results will be obtained until a maximum of 3 attempts. In the IRCA-sham group only the IVC plasma will be tested and no catheter's repositioning will be undertaken.

The AVS will be performed according to the protocol recently described with bilaterally simultaneous sampling but without metoclopramide stimulation \[5\]. The IRCA will be performed using the procedure on-going at each participating centre. This implies using either an in-house made, or the commercially available semi-quantitative kit (Trust Medical Support Co., Ltd. Fukuoka, Japan).

All procedures will be according to good clinical practice and to the Declaration of Helsinki and the study will started after approval of the Ethics Committee of the University of Padua and, if necessary, of the participating centres.

Primary endpoint Selectivity will be determined on both side by using a value of the selectivity index \> 2.00 as defined in an Expert Consensus Statement of AVS \[9\]. The definition of the selectivity index (SI) has been already reported \[16\]; briefly, this is the ratio between plasma cortisol concentration in each adrenal vein and in the infrarenal inferior vena cava blood. The selectivity index will be determined based on measurement of cortisol in the central laboratory of each center. For quality control purposes aliquots of plasma will be collected in heparina and EDTA for metanephrine and androstenedione measurement in the core lab of the coordinating center.

Sample size calculation and statistical analysis We have calculated that with 100 patients submitted to AVS with a normal procedure (Group A) and 100 patients undergoing AVS with IRCA (Group B), the study will have a 82% power of detecting a significant difference of 18% at a two-sided 0.05 significance level, assuming that the SI in Group A is 67% and in Group B is 85 %.

Discussion Currently randomized clinical trials entail the best methodology to provide high-grade class of recommendation and high level of evidence. Therefore, they represent an inevitable step for introducing novel diagnostic and therapeutic strategies where uncertainties still exist as the subtyping of PA by means of adrenal vein sampling.

In fact, the recent publication of SPARTACUS, a randomized clinical trial in the field of a subtyping of PA, has challenged the Endocrine Society Practice guidelines recommendation of performing AVS in all patients seeking surgical cure of PA, who are reasonable candidate for adrenalectomy in general anaesthesia,according to guidelines. In fact, it showed no outcome differences between an AVS- and a computed tomography- based strategy for PA subtyping \[18\], thus adding a good deal of fuel to the controversy on whether to submit or not all PA to AVS before referring them for adrenalectomy. Although the study was widely criticized and, moreover was not adequately powered, it is altogether evident that in current clinical practice the diagnostic performance of AVS is far from optimal worldwide as shown in the AVIS Study.

Hence, efforts aimed at proving the usefulness of novel strategies for improving the rate of selective AVS studies entail a much worth effort, which should be undertaken by exploiting the RCT methodology. We therefore expect that studies, as the one herein described, being adequately powered from the statistical standpoint, can provide a definitive answer to the question of the whether IRCA can increase the rate of selectivity of AVS. Specifically, we expect to be able to detect a difference of about 18%, e.g. from 67% to 85%, in the rate of bilateral selectivity between the arms.

To date, only one study using a single commercially available kit for semiquantitative IRCA has exploited use of a randomized design to prove the usefulness of this strategy for improving the success rate of AVS in Japan \[14\]. Unfortunately, most recruited centres and radiologists were not proficient in performing the procedure, which might explain the remarkable advantage seen with IRCA. Hence, it remains to be demonstrated if use of the IRCA can provide similar advantages in different settings as referral centres endowed with radiologists that are proficient in performing AVS. Once verified, or disproved, this hypothesis will have an impact on widespread adoption or abandoning of the IRCA in clinical practice.

In summary, testing the usefulness of an IRCA for increasing the success rate of AVS in a multi-centre randomized clinical trial as that herein described is expected to fill an important gap of information in the field of subtyping of PA. This increased knowledge will ultimately improve the diagnostic use of AVS, which remain the key test for referring PA patients for adrenalectomy.

Rapid Cortisol Assay in Adrenal Vein Sampling

The Intra-Procedural Cortisol Assay During Adrenal Vein Sampling: Rationale andDesign of A Randomized Study (I-PADUA)

Selectivity will be determined on both side by using a value of the selectivity index \> 2.00 as defined in an Expert Consensus Statement of AVS. Selectivity is the ratio between plasma cortisol concentration in each adrenal vein and in the infrarenal inferior vena cava blood.

University Hospital Padova

Professor of Medicine

Heart and Blood Diseases

Hypertension

Vascular Diseases

Renal sympathetic Denervation are conducted from the adventitia of renal artery

Renal Sympathetic Denervation are not conducted in control group.

We applied a ablation catheter for discrete radiofrequency ablations of 8 W or less and lasting up to 2 min each to obtain up to four-six ablations separated both longitudinally and rotationally from the adventitia

Renal Sympathetic Denervation

ChuanYu Gao, Dr.

Dayi Hu, Dr.

Renal sympathetic denervation from the intima of renal arteries has become an important method for the treatment of resistant hypertension, but renal sympathetic nerve are mainly located in the adventitia, and there is no report about renal sympathetic denervation from the renal adventitia. Primary aldosteronism is an important factor of secondary hypertension, tumor aldosterone in unilateral adrenal can increase the concentration of plasma aldosterone, in some patients blood pressure control is still not desirable after resection of tumor aldosterone. This study intends to conduct renal sympathetic denervation ablation from the adventitia to observe its efficacy and safety on blood pressure of patients with primary aldosterone.

Renal sympathetic denervation from the intima of renal arteries has become an important method for the treatment of resistant hypertension, but renal sympathetic nerve are mainly located in the adventitia, and there is no report about renal sympathetic denervation from the renal adventitia. Primary aldosteronism is an important factor of secondary hypertension, tumor aldosterone in unilateral adrenal can increase the concentration of plasma aldosterone, in some patients blood pressure control is still not desirable after resection of tumor aldosterone.

This study intends to conduct renal sympathetic denervation ablation（RDN）from the adventitia to observe its efficacy and safety on blood pressure of patients with primary aldosterone.

Renal Sympathetic Denervation From The Adventitia on Hypertension

Efficacy and Safety of Renal Sympathetic Denervation From The Adventitia on Hypertension in Patients With Primary Aldosteronism

The Change of Systolic Blood Pressure from Baseline to 6 months,12 months, 18 months

The Change of Renin from Baseline to 6 months,12 months, 18 months

The Change of aldosterone from Baseline to 6 months,12 months, 18 months

Henan Institute of Cardiovascular Epidemiology

Principal Investigator

Patients who underwent adrenalectomy for primary aldosteronism in case of an aldosterone-producing-adenoma

Unilateral adrenalectomy

Menno R Vriens, MD

Gerlof D Valk, MD

Primary aldosteronism (PA) is the excessive endogenous production of the mineralocorticoid aldosterone. Although various rare forms of PA exist, the vast majority of cases are accounted by either an aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia. During the last decades the prevalence of PA has risen, predominantly due to better awareness of disease. Several studies estimated a prevalence of PA up to 17% in an unselected population of hypertensive patients. However, in a population with resistant hypertension the reported prevalence is even higher: 17-23%. This emphasizes the clinical impact of PA on morbidity and mortality due to high blood pressure. Since both hypertension and aldosteronism are independent risk factors for cardiovascular morbidity, the aim of treatment is curation or reduction of both.

After an adrenalectomy for APA normalization of biochemical abnormalities is achieved in almost all cases. Nevertheless, curation of hypertension (systolic blood pressure \<140 and diastolic blood pressure \<90 mmHg) without the need of antihypertensive medication is accomplished in only 35-45% of the cases. In 2008 the Aldosteronoma Resolution Score (ARS) was developed. This score predicts the likelihood of complete resolution of the hypertension in patients with an aldosteronoma and has been validated by other investigator groups.

Reduction of hypertension is also an important clinical outcome and is reported in 90-98% of the patients after surgery. In most studies reduction is defined as a certain decrease in blood pressure or antihypertensive medication. However, there is no consensus on the precise definition of reduction in these patients, which leads to incomparable results.

The aim of the proposed study is to determine the proportion of patients with clinically relevant reduction of hypertension after adrenalectomy in a large cohort. Furthermore, the investigators aim to determine the characteristics predicting this clinically relevant reduction. Additionally, the investigators evaluate the predictive value of the Aldosteronoma Resolution Score for clinically relevant reduction and aim to develop a scoring system to help clinicians predict the likelihood of reduction of hypertension after adrenalectomy so it can be used for patient counseling.

Predicting Reduction of Hypertension After Adrenalectomy for Primary Aldosteronism: a Multicenter Analysis

Characteristics Predicting Clinically Relevant Reduction of Hypertension Following Adrenalectomy for Primary Aldosteronism: a Multicenter Analysis

systolic and diastolic blood pressure via office blood pressure measurements

number of antihypertensives in defined daily dose

resolution of hypertension score via the PASO consensus criteria

Aldosterone to renin ratio using plasma aldosterone level and plasma renin activity

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Outcome of Patients With Primary Aldosteronism	NCT04428827	Primary Aldoste... Primary Aldoste... Primary Aldoste... Adrenalectomy; ... Mineralocortico... Mineralocortico... Cardiovascular ... Chronic Renal D... Hypokalemia	Unilateral adre...	14 Years - 100 Years	Changi General Hospital
Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism	NCT03174847	Primary Aldoste... Primary Aldoste... Primary Aldoste...	Adrenalectomy Mineralocortico...	21 Years - 80 Years	Changi General Hospital
First-in-human Evaluation of [18F]CETO	NCT05361083	Primary Aldoste... Primary Aldoste... Adrenal Cushing... Non-Secretory A... Adrenocortical ...	F18CETO	18 Years -	Uppsala University
Spatial Proteomics Profiles of Aldosterone-producing Adenoma and Unilateral Hyperplasia	NCT05927961	Primary Aldoste... Primary Aldoste...	histopathology	18 Years - 70 Years	Third Military Medical University
Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism	NCT03174847	Primary Aldoste... Primary Aldoste... Primary Aldoste...	Adrenalectomy Mineralocortico...	21 Years - 80 Years	Changi General Hospital
Rapid Cortisol Assay in Adrenal Vein Sampling	NCT03449797	Primary Aldoste...	AVS performed w... AVS performed p...	18 Years - 75 Years	University Hospital Padova
Renal Sympathetic Denervation From The Adventitia on Hypertension	NCT02642445	Primary Aldoste...	Renal Sympathet...	18 Years - 70 Years	Henan Institute of Cardiovascular Epidemiology
Predicting Reduction of Hypertension After Adrenalectomy for Primary Aldosteronism: a Multicenter Analysis	NCT04761354	Primary Aldoste... Primary Aldoste... Primary Aldoste...	Unilateral adre...	18 Years -	UMC Utrecht

Spots Global Cancer Trial Database for primary aldosteronism due to aldosterone producing adenoma