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  1. Book ; Thesis: Akute Volumenbelastung und Aldosteronmetabolite im Urin in der Bestätigungsdiagnostik des Conn-Syndroms

    Schirpenbach, Caroline

    Untersuchungen an Probanden, essentiellen Hypertonikern und Patienten mit normo- und hypokaliämischen Conn-Syndrom

    2004  

    Author's details vorgelegt von Caroline Schirpenbach
    Language German
    Size II, 49 Bl. : graph. Darst.
    Edition [Mikrofiche-Ausg.]
    Publishing country Germany
    Document type Book ; Thesis
    Thesis / German Habilitation thesis Freiburg (Breisgau), Univ., Diss., 2005
    HBZ-ID HT014735665
    Database Catalogue ZB MED Medicine, Health

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  2. Article: Primary aldosteronism: current knowledge and controversies in Conn's syndrome.

    Schirpenbach, Caroline / Reincke, Martin

    Nature clinical practice. Endocrinology & metabolism

    2007  Volume 3, Issue 3, Page(s) 220–227

    Abstract: Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of the hypertensive population. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, ...

    Abstract Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of the hypertensive population. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass. The most advocated screening test at present is the aldosterone-to-renin ratio, which has a high sensitivity but low specificity. The specificity increases if patients with low aldosterone concentrations are excluded. Published cut-off values vary depending on the hormone assay and the investigated population. Before screening, antihypertensive treatment, especially aldosterone antagonists and beta-blockers, should be discontinued. A pathologic result requires additional work up to prove mineralocorticoid excess. Subtype differentiation is performed by adrenal venous sampling combined with imaging (CT or MRI). One-third of cases are due to aldosterone-producing adenomas, for which the preferred treatment is laparoscopic adrenalectomy. Bilateral adrenal hyperplasia (idiopathic aldosteronism) underlies two-thirds of cases and requires treatment with aldosterone antagonists. Treatment is started with low doses of spironolactone (25-50 mg once daily), which often results in substantial improvements in hypertension.
    MeSH term(s) Algorithms ; Humans ; Hyperaldosteronism/classification ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/epidemiology ; Hyperaldosteronism/etiology ; Prevalence
    Language English
    Publishing date 2007-03
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2228540-4
    ISSN 1745-8366
    ISSN 1745-8366
    DOI 10.1038/ncpendmet0430
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Screening for primary aldosteronism.

    Schirpenbach, Caroline / Reincke, Martin

    Best practice & research. Clinical endocrinology & metabolism

    2006  Volume 20, Issue 3, Page(s) 369–384

    Abstract: Normokalaemic manifestation of primary aldosteronism is a frequent cause of secondary hypertension. It occurs in approximately 5-12% of all patients with hypertension, primarily patients with severe and uncontrolled blood pressure. Main causes are ... ...

    Abstract Normokalaemic manifestation of primary aldosteronism is a frequent cause of secondary hypertension. It occurs in approximately 5-12% of all patients with hypertension, primarily patients with severe and uncontrolled blood pressure. Main causes are bilateral adrenal hyperplasia (2/3 of cases) and aldosterone-producing adenoma (1/3 of cases). Screening is performed by measurement of the aldosterone/renin ratio, which is raised in affected patients. Suspicion of primary aldosteronism due to a pathological ratio requires confirmatory testing e.g. by saline infusion test or fludrocortisone suppression test. If the diagnosis is confirmed, the underlying cause of aldosterone excess needs to be identified because therapy differs. First, adrenal imaging (CT/MRI) is performed, which is followed by postural testing in cases with a unilateral lesion. Concordant results confirm the diagnosis of an aldosterone-producing adenoma and allow treatment to proceed to adrenalectomy. In cases of equivocal results or normal/bilaterally enlarged adrenal glands on imaging, adrenal venous sampling must be performed for subtype differentiation.
    MeSH term(s) Aldosterone/analysis ; Algorithms ; Humans ; Hyperaldosteronism/classification ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/epidemiology ; Hyperaldosteronism/etiology ; Hypertension/etiology ; Potassium/blood ; Prevalence ; Renin/analysis
    Chemical Substances Aldosterone (4964P6T9RB) ; Renin (EC 3.4.23.15) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2006-09
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2052339-7
    ISSN 1532-1908 ; 1521-690X
    ISSN (online) 1532-1908
    ISSN 1521-690X
    DOI 10.1016/j.beem.2006.07.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Trotz Kombinationstherapie bleibt der Blutdruck oben. Häufiger als vermutet ist ein primärer Hyperaldosteronismus schuld.

    Diderich, Sven / Willenberg, Holger S / Schirpenbach, Caroline / Hahner, Stefanie / Quinkler, Marcus

    MMW Fortschritte der Medizin

    2010  Volume 152, Issue 7, Page(s) 32–35

    Title translation Primary hyperaldosteronism--more common than previously thought.
    MeSH term(s) Algorithms ; Antihypertensive Agents/administration & dosage ; Diagnosis, Differential ; Drug Therapy, Combination ; Humans ; Hyperaldosteronism/complications ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/therapy ; Hypertension/drug therapy ; Hypertension/etiology ; Mass Screening ; Treatment Failure
    Chemical Substances Antihypertensive Agents
    Language German
    Publishing date 2010-02-18
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1478211-x
    ISSN 1438-3276
    ISSN 1438-3276
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Primärer Hyperaldosteronismus

    Schirpenbach, Caroline / Reincke, Martin

    CME praktische Fortbildung : CME Innere Medizin

    2009  Volume -, Issue 1, Page(s) 2

    Language German
    Document type Article
    ZDB-ID 2483450-6
    ISSN 1614-8541
    Database Current Contents Medicine

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  6. Article: Endokrinologie, Diabetologie. Primärer Hyperaldosteronismus

    Schirpenbach, Caroline / Reincke, Martin

    CME praktische Fortbildung : CME innere Medizin

    2009  Volume -, Issue 1, Page(s) 2

    Language German
    Document type Article
    ZDB-ID 2483450-6
    Database Current Contents Medicine

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  7. Article: Automated chemiluminescence-immunoassay for aldosterone during dynamic testing: comparison to radioimmunoassays with and without extraction steps.

    Schirpenbach, Caroline / Seiler, Lysann / Maser-Gluth, Christiane / Beuschlein, Felix / Reincke, Martin / Bidlingmaier, Martin

    Clinical chemistry

    2006  Volume 52, Issue 9, Page(s) 1749–1755

    Abstract: Background: Measurements of aldosterone have become more common since the recognition that primary aldosteronism is a more frequent cause of hypertension than previously believed. Our aim was to compare concentrations reported by 4 assays for samples ... ...

    Abstract Background: Measurements of aldosterone have become more common since the recognition that primary aldosteronism is a more frequent cause of hypertension than previously believed. Our aim was to compare concentrations reported by 4 assays for samples obtained after saline infusion during dynamic testing.
    Methods: We tested 104 participants (27 with primary aldosteronism, 30 with essential hypertension, and 47 healthy controls) with the intravenous saline infusion test (2.0 L isotonic saline over 4 h), with repetitive sampling. In all blood samples, aldosterone concentration was measured by an in-house RIA after extraction and chromatography, by 2 commercially available RIAs without extraction (Aldosterone Maia, Adaltis; Active Aldosterone, Diagnostics Systems Laboratories) and by an automated CLIA (Advantage, Nichols Institute Diagnostics).
    Results: Correlation coefficients for results of pairs of assays ranged from 0.74 to 0.98. Agreement between commercial assays and in-house RIA was best at the low to intermediate concentrations after saline infusion. Mean (SD) Adaltis and DSL RIA results were 2- to 3-times higher [healthy participants: 78 (25) ng/L and 56 (18) ng/L, respectively] than those obtained by Nichols CLIA [17 (8) ng/L] and in-house RIA [23 (18) ng/L]. Aldosterone concentrations measured by the Nichols CLIA were below the limit of detection (limit of the blank) in 27 of 47 healthy participants.
    Conclusions: Aldosterone concentrations reported by the Adaltis and DSL nonextraction RIAs were consistently higher than those produced by the Nichols CLIA and the in-house RIA. The convenient Nichols CLIA showed better agreement with the in-house RIA, but the concentrations in healthy participants were frequently undetectable by this method. Uncritical application of cutoff values from the literature must be avoided.
    MeSH term(s) Adult ; Aldosterone/blood ; Autoanalysis ; Female ; Humans ; Hyperaldosteronism/diagnosis ; Immunoassay ; Luminescent Measurements ; Male ; Middle Aged ; Radioimmunoassay/methods ; Reference Values
    Chemical Substances Aldosterone (4964P6T9RB)
    Language English
    Publishing date 2006-07-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 80102-1
    ISSN 1530-8561 ; 0009-9147
    ISSN (online) 1530-8561
    ISSN 0009-9147
    DOI 10.1373/clinchem.2006.068502
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Therapieresistente Hypertonie: Hormon-Check nicht vergessen!

    Schirpenbach, Caroline / Reincke, Martin / Beuschlein, Felix

    Der Allgemeinarzt

    2008  Volume 30, Issue 11, Page(s) 6

    Language German
    Document type Article
    ZDB-ID 603653-3
    ISSN 0172-7249
    Database Current Contents Medicine

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  9. Article: Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites.

    Schirpenbach, Caroline / Seiler, Lysann / Maser-Gluth, Christiane / Rüdiger, Frank / Nickel, Christian / Beuschlein, Felix / Reincke, Martin

    European journal of endocrinology

    2006  Volume 154, Issue 6, Page(s) 865–873

    Abstract: Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline ... ...

    Abstract Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline aldosterone/renin ratio may be insufficient, diagnosis should be confirmed by additional tests. However, as most confirmatory tests have been evaluated in hypokalaemic primary aldosteronism only, we reassessed the value of the saline infusion test and 24 h urinary aldosterone metabolites as confirmatory tests for both normo- and hypokalaemic primary aldosteronism under current antihypertensive medication.
    Patients and methods: 25 patients with primary aldosteronism (11 hypokalaemic, 14 normokalaemic), 29 patients with essential hypertension and 47 normotensive subjects were studied. The hypertensives received their usual medication with the exception of spironolactone. All subjects underwent a standard saline infusion test (determination of plasma aldosterone before and after 2.0 liters of isotonic saline for 4 hours i.v.) and collected a 24 h urine sample for examination of urinary tetrahydroaldosterone and aldosterone-18-glucuronide.
    Results: In hypokalaemic primary aldosteronism the saline infusion test showed a reasonable sensitivity (91%) and specificity (90%). However, the test failed to differentiate sufficiently between essential hypertension and normokalaemic primary aldosteronism (sensitivity 57%, specificity 90%). Similarly, urinary tetrahydroaldosterone had higher sensitivity in hypokalaemic than in normokalaemic primary aldosteronism (sensitivity 64% vs 36%, specificity 100%), whereas for aldosterone-18-glucuronide, no differences in hypo- and normokalaemic primary aldosteronism were found (sensitivity 45% and 43%, specificity 100%).
    Conclusions: These data show that the saline infusion test as an established test in classical hypokalaemic primary aldosteronism is not a reliable test in the normokalaemic variant of the disease. Due to its low accuracy, determination of urinary aldosterone metabolites did not prove useful in confirming either normo- or hypokalaemic patients. We conclude from our data that these tests should not be used as confirmatory testing in the normokalaemic variant of primary aldosteronism.
    MeSH term(s) Adult ; Aldosterone/metabolism ; Aldosterone/urine ; False Negative Reactions ; Female ; Humans ; Hyperaldosteronism/diagnosis ; Hypertension/diagnosis ; Hypokalemia/diagnosis ; Infusions, Intravenous ; Male ; Middle Aged ; Sodium Chloride/administration & dosage
    Chemical Substances Sodium Chloride (451W47IQ8X) ; Aldosterone (4964P6T9RB)
    Language English
    Publishing date 2006-06
    Publishing country England
    Document type Journal Article ; Validation Studies
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1530/eje.1.02164
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry.

    Schirpenbach, Caroline / Segmiller, Felix / Diederich, Sven / Hahner, Stefanie / Lorenz, Reinhard / Rump, Lars C / Seufert, Jochen / Quinkler, Marcus / Bidlingmaier, Martin / Beuschlein, Felix / Endres, Stephan / Reincke, Martin

    Deutsches Arzteblatt international

    2009  Volume 106, Issue 18, Page(s) 305–311

    Abstract: Background: Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been ... ...

    Abstract Background: Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been standardized.
    Methods: The authors retrospectively analyzed data of 555 patients (327 men and 228 women, aged 55 +/- 13 years) who were treated for primary hyperaldosteronism in 5 different centers from 1990 to 2006. The objective was to determine center-specific features of diagnosis and treatment.
    Results: 353 (63%) of the patients had the hypokalemic variant of primary hyperaldosteronism; 202 never had documented hypokalemia. The centers differed markedly with respect to the patients' clinical presentation, diagnostic testing of endocrine function, and diagnostic imaging techniques, including adrenal venous sampling. The adrenalectomy rate ranged from 15% to 46%.
    Conclusions: The registry data reveal an unexpected heterogeneity in the diagnostic evaluation and treatment of primary hyperaldosteronism. National or international guidelines are needed so that these can be standardized.
    MeSH term(s) Female ; Germany/epidemiology ; Humans ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/epidemiology ; Hyperaldosteronism/therapy ; Incidence ; Male ; Middle Aged ; Registries ; Risk Assessment ; Risk Factors
    Language English
    Publishing date 2009-05-01
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2406159-1
    ISSN 1866-0452 ; 1866-0452
    ISSN (online) 1866-0452
    ISSN 1866-0452
    DOI 10.3238/arztebl.2009.0305
    Database MEDical Literature Analysis and Retrieval System OnLINE

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