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Primary Aldosteronism in the Elderly.

Paolo Mulatero1, Jacopo Burrello1, Tracy Ann Williams1,2

  • 1Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy.

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|April 19, 2020
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Summary
This summary is machine-generated.

Primary aldosteronism (PA) screening is expanding to include the elderly. Aging affects the renin-angiotensin-aldosterone system (RAAS), altering aldosterone production and potentially reducing surgical benefits for older PA patients.

Keywords:
adrenalaldosteroneelderlyprimary aldosteronismsecondary hypertension

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Area of Science:

  • Endocrinology
  • Gerontology
  • Cardiovascular Medicine

Background:

  • Primary aldosteronism (PA) is the most common cause of endocrine hypertension.
  • Growing evidence links PA to adverse cardiovascular outcomes, necessitating broader screening, including in the elderly.
  • Recent advancements have improved understanding of PA's molecular mechanisms.

Purpose of the Study:

  • To review the impact of aging on the renin-angiotensin-aldosterone system (RAAS) and adrenal histopathology in primary aldosteronism.
  • To synthesize current knowledge on age-related changes in PA relevant to clinical practice and diagnosis.

Main Methods:

  • Systematic literature search of PubMed.
  • Focused on studies concerning RAAS, PA, and adrenal histopathology in the elderly population.

Main Results:

  • Aging is associated with decreased RAAS activity and aldosterone response to sodium intake.
  • Histological changes include reduced CYP11B2 expression and increased aldosterone-producing cell clusters with age.
  • Older patients with unilateral PA may experience less benefit from adrenalectomy.

Conclusions:

  • RAAS physiology and regulation exhibit age-related alterations.
  • Further research is needed to understand how these age-related variations impact PA diagnostic workup.