Sex Difference in the Association Between Subtype Distribution and Age at Diagnosis in Patients With Primary Aldosteronism


Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Adrenal vein sampling (AVS) is an established method for finding patients with the unilateral subtype of PA, for which adrenalectomy is an applicable treatment. In this study, we analyzed a large database of patients with PA who underwent adrenal vein sampling, to investigate the sex differences in the impact of age at diagnosis on the subtype and cause of PA. In 2122 patients, women with the unilateral subtype were younger than men with the same subtype and women with the bilateral subtype. Younger age and older age were associated with unilateral PA in women and men, respectively. After stratification by tertiles of age, there was a trend of decreased and increased incidence of unilateral PA with aging in women and men, respectively. Male sex was a predictor of unilateral PA in middle-aged and older patients but not in younger patients. We also found that obesity, a known factor associated with idiopathic hyperaldosteronism, was positively associated with bilateral PA in younger patients but not in older patients. These findings suggest that the proportion of operable patients with unilateral PA differs depending on the combination of sex and age, and that other than obesity, the cause of PA is also associated with the bilateral subtype in older patients.

Authors: Hiroshi Akasaka, Koichi Yamamoto, Hiromi Rakugi, Motonori Nagasawa, Ryo Nakamaru, Takamasa Ichijo, Yoshiyu Takeda, Isao Kurihara, Takuyuki Katabami, Mika Tsuiki, Norio Wada, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Kohei Kamemura, Takanobu Yoshimoto, Yuichi Matsuda, Megumi Fujita, Hiroki Kobayashi, Minemori Watanabe, Kouichi Tamura, Shintaro Okamura, Shozo Miyauchi, Shoichiro Izawa, Yoshiro Chiba, Akiyo Tanabe, Mitsuhide Naruse; Japan Primary Aldosteronism Study Group
Keywords: sex difference, age difference, subtype
DOI Number: 10.1161/HYPERTENSIONAHA.119.13006      Publication Year: 2019

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