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Published on: September 15, 2017
Prevalence of Malignancies in Patients With Primary Aldosteronism
K Lang1, K Weber1, M Quinkler1
1Department of Internal Medicine I (K.L., K.W., B.H., B.A., S.H.), University Hospital Würzburg, 97080 Würzburg, Germany; Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin, 10117 Berlin, Germany; Medizinische Klinik und Poliklinik IV (A.S.D., M.R.), University Hospital Munich, 80336 Munich, Germany; Institute of Clinical Chemistry and Laboratory Medicine (H.W., A.H., N.F.), University Medicine Greifswald, 17489 Greifswald, Germany; Private Practice Endocrinology (H.W.), 99084 Erfurt, Germany; Department of Nephrology, Medical Faculty (L.C.R., I.Q.), Heinrich-Heine University Düesseldorf, 40225 Düsseldorf, Germany; and Department of Endocrinology and Metabolism (H.S.W.), Rostock University Medical Center, 18147 Rostock, Germany; Comprehensive Cancer Center Mainfranken & Department of Medicine I (C.T.F.), University of Wuerzburg, 97080 Wuerzburg, Germany.
Context:
Primary aldosteronism (PA) is the most common cause of secondary hypertension. Aldosterone excess can cause DNA damage in vitro and in vivo. Single case reports have indicated a coincidence of PA with renal cell carcinoma and other tumors. However, the prevalence of benign and malignant neoplasms in patients with PA has not yet been studied.
Patients And Design:
In the multicenter MEPHISTO study, the prevalence of benign and malignant tumors was investigated in 335 patients with confirmed PA. Matched hypertensive subjects from the population-based Study of Health in Pomerania cohort served as controls.
Results:
Of the 335 PA patients, 119 (35.5%) had been diagnosed with a tumor at any time, and 30 had two or more neoplasms. Lifetime malignancy occurrence was reported in 9.6% of PA patients compared to 6.0% of hypertensive controls (P = .08). PA patients with a history of malignancy had higher baseline aldosterone levels at diagnosis of PA (P = .009), and a strong association between aldosterone levels and the prevalence of malignancies was observed (P = .03). In total, 157 neoplasms were identified in the PA patients; they were benign in 61% and malignant in 25% of the cases (14% of unknown dignity). Renal cell carcinoma was diagnosed in five patients (13% of all malignancies) and was not reported in controls
Conclusion:
Compared to hypertensive controls, the prevalence of malignancies was positively correlated with aldosterone levels, tended to be higher in PA patients, but did not differ significantly.
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