DÄ internationalArchive42/2009The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany—Results on 555 Patients From the German Conn Registry: In reply

Correspondence

The Diagnosis and Treatment of Primary Hyperaldosteronism in Germany—Results on 555 Patients From the German Conn Registry: In reply

Dtsch Arztebl Int 2009; 106(42): 692. DOI: 10.3238/arztebl.2009.0692b

Reincke, M

LNSLNS Dr Jürgen Sindermann’s letter provides us with an opportunity to go into greater detail about the prevalence of Conn’s syndrome. The detection rate of primary hyperaldosteronism depends on two factors: firstly, the biochemical screening strategy, and secondly, the pretest probability in the particular cohort under investigation. If in one practice’s cohort of hypertension patients only hypokalemic hypertension patients are examined for Conn’s syndrome, the detection rate, relative to all hypertension patients, is less than 1%, 1–4% in specialized hypertension outpatient clinics. If, however, all hypertension patients—independently of their hypokalemic status—are screened by using the aldosterone-renin ratio, the detection rate is 4–13%. The prevalence of Conn’s syndrome increases with the severity of the hypertension. The prevalence in patients with grade 1 hypertension according to World Health Organization criteria is 2% and in patients with grade 3 hypertension, 13% (1). The highest detection rate applies to therapy resistant hypertension, at 11–30% (2). Only few population based studies have been conducted to date. In the Framingham Offspring Cohort, a raised aldosterone-renin ratio was found in 8% of untreated hypertensive men. Subjects with the highest aldosterone-renin ratio in this study had a 53% increased risk of developing hypertension. In sum, these data allow the conclusion that primary hyperaldosteronism is indeed much more common than hitherto assumed. The fact that the case numbers in the German Conn Registry do not reflect this is due to the conservative screening strategies employed by the participating centers. In most cases, the patients who were investigated were hypokalemic—this is in contrast to the international trend, where, increasingly, normokalemic variants of hyperaldosteronism are seen. The study structure of the registry (longitudinal cohort study) is fundamentally inappropriate as a basis for calculating prevalence rates in Germany.
DOI: 10.3238/arztebl.2009.0692b

Prof. Dr. med. Martin Reincke
Medizinische Klinik – Innenstadt
Klinikum der Universität München
Ziemssenstr 1
80336 München, Germany
martin.reincke@med.uni-muenchen.de

Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Mosso L, Carvajal C, González A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE: Primary aldosteronism and hypertensive disease. Hypertension. 2003 Aug; 42(2): 161–5. Epub 2003 Jun 9.
2.
Schirpenbach C, Reincke M: Epidemiologie und Ursachen der Therapie-resistenten Hypertonie. Internist 2009; 50(1): 7–16.
3.
Schirpenbach C, Segmiller F, Diederich S, et al.: The diagnosis and treatment of primary hyperaldosteronism in Germany—results on 555 patients from the German Conn Registry [Diagnostik und Therapie des primären Hyperaldosteronismus – Ergebnisse des deutschen Conn-Registers: 555 Patienten mit primärem Hyeraldosteronismus]. Dtsch Arztebl Int 2009; 106(18): 305–11.
1. Mosso L, Carvajal C, González A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE: Primary aldosteronism and hypertensive disease. Hypertension. 2003 Aug; 42(2): 161–5. Epub 2003 Jun 9.
2. Schirpenbach C, Reincke M: Epidemiologie und Ursachen der Therapie-resistenten Hypertonie. Internist 2009; 50(1): 7–16.
3. Schirpenbach C, Segmiller F, Diederich S, et al.: The diagnosis and treatment of primary hyperaldosteronism in Germany—results on 555 patients from the German Conn Registry [Diagnostik und Therapie des primären Hyperaldosteronismus – Ergebnisse des deutschen Conn-Registers: 555 Patienten mit primärem Hyeraldosteronismus]. Dtsch Arztebl Int 2009; 106(18): 305–11.