Primary aldosteronism: who should be screened?

Primary aldosteronism (PA) has a prevalence in the general hypertensive population from 5 to 10%, and is widely recognized as the most frequent form of secondary hypertension. The 2 main PA subtypes are aldosterone producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) that account for 95% of all PA cases. The diagnosis of PA is a 3-step process that comprises screening, confirmatory testing, and subtype differentiation. The different categories of patients at an increased risk of PA who should thus undergo a screening test were described in the first Endocrine Society (ES) Practice Guidelines for diagnosis and treatment of PA published in 2008. These categories include patients with Joint National Committee Stage 2, Stage 3, or drug-resistant hypertension; hypertension, and spontaneous or diuretic-induced hypokalemia; hypertension with adrenal incidentaloma; hypertension and a family history of early-onset hypertension or cerebrovascular accident at a young age and all hypertensive first degree relatives of patients with PA. Recently, a growing number of studies have linked PA with the metabolic syndrome, diabetes, and obstructive sleep apnea that may be partly responsible for the higher rate of cardio and cerobrovascular accidents in PA patients. The aim of this review is to discuss, which patients should be screened for PA, focusing not only on the well-established categories of the ES Guidelines, but also on additional other group of patients with a potentially high prevalence of PA that has emerged from recent research.

[Biliary ileus caused by incarceration of a large gallbladder calculus in the duodenal bulb in a young man]. / Ileo biliare da incarceramento di grosso calcolo colecistico nel bulbo duodenale in un giovane uomo.

A case of gallstone ileus is presented, secondary to a biliary-enteric fistula with obstruction of the duodenal bulb, in a 23 year-old man. The patient underwent exploratory laparotomy because his clinical condition was deteriorating steadily. An intraoperative diagnosis of gallstone ileus was formulated; a cholecystectomy and a suture of the duodenal opening were carried out.

[Parenteral and enteral nutrition in esophageal stenosis. Initial clinico-experimental results]. / La nutrizione parenterale ed enterale nelle stenosi esofagee. Prime risultanze clinico-sperimentali.

The Authors study the pre- and post-operative nutritional treatment of the patients suffering from oesophageal stenosis, principally neoplastic, waiting to undergo the radical operation. Although the compensation of the nutritional situation of these patients through the enteral and parenteral nutrition results difficult to be effected, the results encourage to apply this clinical practice everywhere a demolitive operation, always long, heavy, and burdened by a high morbidity and mortality, is foreseen.

[Esophago-gastro-enteric manifestations of scleroderma. Apropos of a clinical case]. / Le manifestazioni esofago-gastro-enteriche nella sclerodermia. A proposito di un caso clinico.

Starting from the observation of a case of scleroderma with oesophageal location, the Authors study the digestive troubles of such disease, and remark that, in some cases, the treatment with cimetidin can give good results as to symptomatology, in spite of the chronic evolution of the disease.