Early diagnosis of PA would definitely save many lives: morbidity of PA subjects
compared with matched hypertensives is substantially increased at the time of
diagnosis [4]. Despite this unfavorable
baseline situation, the long-term prognosis is excellent with specific treatment
measures, unilateral adrenalectomy for a unilateral adenoma, and mineralocorticoid
antagonist treatment for bilateral adrenal hyperplasia. In a recent meta-analysis,
long-term mortality of patients with PA, independent of subtype, decreased
progressively at year 5 and 7 below the level of primary hypertension, an effect
even more pronounced in unilateral PA following unilateral adrenalectomy [5].
It has become a tradition for clinicians and researchers to meet every second year
in
Munich at a conference called “Progress in Primary Aldosteronism”.
From October 13 to October 15, 2019 we held the 6th conference at the Carl Friedrich
von Siemens Stiftung and celebrated the 10th anniversary with a focus on
“New Players on the Block”. The primary focus of the meeting
remained: to advance the knowledge of PA and to discuss new concepts of diagnosis
and treatment. However, at this anniversary the organizers also concentrated on
topics and speakers who had not been present in the past. Owing to the special
genius loci of the Carl Friedrich von Siemens Foundation at the
Nymphenburg castle, and the enthusiasm of more than 100 attending scientists from
Europe and overseas, the meeting gave another excellent example of a successful,
international, medium-sized disease-oriented symposium.
With the generous support of the Deutsche Forschungsgemeinschaft and the
Carl Friedrich von Siemens Stiftung we were able to invite most of the
internationally renowned primary aldosteronism experts. The present volume of
Hormone and Metabolic Research is entirely dedicated to reviews based on
PIPA-6 presentations and gives an excellent overview over the current status of the
field.
The manuscripts are organized according to their relation to the diagnostic and
therapeutic challenges of PA. The study of Gruber and Beuschlein [6] analyses the relevance of hypokalemia as a
lead symptom for PA. An important clinical manifestation of PA is atrial
fibrillation, as outlined by the study of Pan et al. [7]. A conundrum has been the association
between PA and obstructive sleep apnea syndrome, which has recently received quite
some attention and is covered in this issue by Pecori et al. [8]. Wannachalee and Turcu [9] review the diagnostic value and
pathophysiologic implications of steroid profiles determined by liquid
chromatography mass spectrometry, an area which has attracted substantial attention
in recent years. Similarly, agonistic angiotensin II type 1 receptor antibodies have
become a hot topic in aldosterone research and will be covered by the review article
of Meyer et al. [10]. A neglected area of PA
research is the regulation of sodium chloride in states of normal and excess
aldosterone secretion, as covered by the article by Adolf et al. [11]. Tömböl et al. reviews the
evidence for micro RNA as novel markers in the diagnostic work-up of PA [12]. In an original publication, Handgriff et
al. analyze the association between glucocorticoid co-secretion, assessed by the 1
mg dexamethasone suppression test, on the prevalence and the time course of thyroid
antibodies in PA [13]. In a series of
pathophysiologic manuscripts, the role of mast cells [14], expression of aldosterone synthase in
adrenalectomy samples [15], the role of
aldosterone producing cell clusters [16], and
the methodologic advances obtained by tissue mass spectrometry imaging [17] are analyzed. Finally, the study of Gao et
al. [18] gives a comprehensive overview on
calcium metabolism in PA, followed by an in-depth study on clinical determinants of
surgical success by Naruse et al. [19]. The
final word and outlook has the nestor of primary aldosteronism research, John
Funder, in his commentary “Primary Aldosteronism: Where Are We Now? Where to
from Here” [20].
This special issue of Hormone and Metabolic Research gives the interested
reader the opportunity to understand where we are, and where our research has to go
until the next PIPA meeting. We would like to thank all authors for their valuable
contributions to this Special Issue.
Martin Reincke, Felix Beuschlein, and Tracy Ann Williams
