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Primary Aldosteronism (Conn's Syndrome) QSP Model — References

Disease: Primary Aldosteronism (PA) / Conn's Syndrome
Model version: 1.0
Date compiled: 2026-06-24

1. Disease Overview & Epidemiology

  1. Conn JW. Primary aldosteronism, a new clinical syndrome. Journal of Laboratory and Clinical Medicine 1955;45(1):3–17.
    https://pubmed.ncbi.nlm.nih.gov/13233623/

  2. Funder JW et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism 2016;101(5):1889–1916.
    https://pubmed.ncbi.nlm.nih.gov/26934393/

  3. Mulatero P et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. Journal of Clinical Endocrinology & Metabolism 2004;89(3):1045–1050.
    https://pubmed.ncbi.nlm.nih.gov/15001582/

  4. Rossi GP et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. Journal of the American College of Cardiology 2006;48(11):2293–2300.
    https://pubmed.ncbi.nlm.nih.gov/17161256/

  5. Käyser SC et al. Prevalence of Primary Aldosteronism in Hypertension: A Meta-Analysis. Journal of Hypertension 2016;34(9):1911–1917.
    https://pubmed.ncbi.nlm.nih.gov/27367805/

  6. Brown JM et al. The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Annals of Internal Medicine 2020;173(1):10–20.
    https://pubmed.ncbi.nlm.nih.gov/32384793/

2. Pathophysiology: RAAS & Autonomous Aldosterone

  1. Spät A, Hunyady L. Control of aldosterone secretion: a model for convergence in cellular signaling pathways. Physiological Reviews 2004;84(2):489–539.
    https://pubmed.ncbi.nlm.nih.gov/15044680/

  2. Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell 2001;104(4):545–556.
    https://pubmed.ncbi.nlm.nih.gov/11239411/

  3. Williams TA et al. Mechanisms of primary aldosteronism. Nature Reviews Endocrinology 2019;15(1):45–54.
    https://pubmed.ncbi.nlm.nih.gov/30390014/

  4. Scholl UI et al. Somatic and germline CACNA1D calcium channel mutations in aldosterone-producing adenomas and primary aldosteronism. Nature Genetics 2013;45(9):1050–1054.
    https://pubmed.ncbi.nlm.nih.gov/23913001/

3. Genetics: APA Somatic Mutations (KCNJ5, CACNA1D, ATP1A1, ATP2B3)

  1. Choi M et al. K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension. Science 2011;331(6018):768–772.
    https://pubmed.ncbi.nlm.nih.gov/21311022/

  2. Beuschlein F et al. Somatic mutations in ATP1A1 and ATP2B3 lead to aldosterone-producing adenomas and secondary hypertension. Nature Genetics 2013;45(4):440–444.
    https://pubmed.ncbi.nlm.nih.gov/23416519/

  3. Azizan EA et al. Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype of adrenal hypertension. Nature Genetics 2013;45(9):1055–1060.
    https://pubmed.ncbi.nlm.nih.gov/23913004/

  4. Akerstrom T et al. Activating mutations in CTNNB1 in aldosterone producing adenomas. Scientific Reports 2016;6:19546.
    https://pubmed.ncbi.nlm.nih.gov/26796337/

  5. Fernandes-Rosa FL et al. Genetic spectrum and clinical correlates of somatic mutations in aldosterone-producing adenoma. Hypertension 2014;64(2):354–361.
    https://pubmed.ncbi.nlm.nih.gov/24866139/

4. CYP11B2 (Aldosterone Synthase)

  1. Lifton RP et al. A chimaeric 11 beta-hydroxylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature 1992;355(6357):262–265.
    https://pubmed.ncbi.nlm.nih.gov/1731223/

  2. Gomez-Sanchez CE et al. Immunohistochemistry of the human adrenal cortex with the use of antibodies to CYP11B1 and CYP11B2. Molecular and Cellular Endocrinology 2014;383(1–2):138–146.
    https://pubmed.ncbi.nlm.nih.gov/24316228/

  3. Young WF Jr. Primary Aldosteronism: Renaissance of a Syndrome. Clinical Endocrinology 2007;66(5):607–618.
    https://pubmed.ncbi.nlm.nih.gov/17492946/

5. Renal Mechanisms: ENaC, ROMK, SGK1

  1. Bhalla V, Hallows KR. Mechanisms of ENaC regulation and clinical implications. Journal of the American Society of Nephrology 2008;19(10):1845–1854.
    https://pubmed.ncbi.nlm.nih.gov/18753254/

  2. Wang WH, Giebisch G. Regulation of potassium (K) handling in the renal collecting duct. Pflügers Archiv — European Journal of Physiology 2009;458(1):157–168.
    https://pubmed.ncbi.nlm.nih.gov/19129992/

  3. Naray-Fejes-Toth A, Canessa C, Cleaveland ES, Bhargava G, Fejes-Toth G. sgk is an aldosterone-induced kinase in the renal collecting duct: effects on epithelial Na+ channels. Journal of Biological Chemistry 1999;274(24):16973–16978.
    https://pubmed.ncbi.nlm.nih.gov/10358044/

  4. Debonneville C et al. Phosphorylation of Nedd4-2 by Sgk1 regulates epithelial Na+ channel cell surface expression. EMBO Journal 2001;20(24):7052–7059.
    https://pubmed.ncbi.nlm.nih.gov/11742982/

6. Diagnosis: ARR Screening, Confirmatory Tests, AVS

  1. Stowasser M et al. Factors affecting the aldosterone/renin ratio. Hormone and Metabolic Research 2012;44(3):170–176.
    https://pubmed.ncbi.nlm.nih.gov/22314740/

  2. Rossi GP et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. Journal of Clinical Endocrinology & Metabolism 2012;97(5):1631–1637.
    https://pubmed.ncbi.nlm.nih.gov/22399511/

  3. Lim V et al. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism. Journal of Clinical Endocrinology & Metabolism 2014;99(8):2712–2719.
    https://pubmed.ncbi.nlm.nih.gov/24758185/

  4. Young WF et al. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004;136(6):1227–1235.
    https://pubmed.ncbi.nlm.nih.gov/15657585/

7. Cardiovascular Complications

  1. Milliez P et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. Journal of the American College of Cardiology 2005;45(8):1243–1248.
    https://pubmed.ncbi.nlm.nih.gov/15837258/

  2. Catena C et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Archives of Internal Medicine 2008;168(1):80–85.
    https://pubmed.ncbi.nlm.nih.gov/18195199/

  3. Reincke M et al. Risk factors associated with a low glomerular filtration rate in primary aldosteronism. Journal of Clinical Endocrinology & Metabolism 2009;94(3):869–875.
    https://pubmed.ncbi.nlm.nih.gov/19106277/

  4. Rossi G et al. Aldosterone-mediated organ damage: animal and human studies. Hypertension 2003;41(3):383–388.
    https://pubmed.ncbi.nlm.nih.gov/12623940/

  5. Stehr CB et al. Increased levels of oxidative stress, subclinical inflammation, and myocardial fibrosis markers in primary aldosteronism patients. Journal of Hypertension 2010;28(10):2120–2126.
    https://pubmed.ncbi.nlm.nih.gov/20657326/

8. Treatment: Adrenalectomy

  1. Sawka AM et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Annals of Internal Medicine 2001;135(4):258–261.
    https://pubmed.ncbi.nlm.nih.gov/11511141/

  2. Rossi GP et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013;62(1):62–69.
    https://pubmed.ncbi.nlm.nih.gov/23716587/

  3. Zarnegar R et al. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Annals of Surgery 2008;247(3):511–518.
    https://pubmed.ncbi.nlm.nih.gov/18376198/

9. Treatment: Mineralocorticoid Receptor Antagonists

  1. Pitt B et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine 1999;341(10):709–717.
    https://pubmed.ncbi.nlm.nih.gov/10471456/

  2. Pitt B et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine 2003;348(14):1309–1321.
    https://pubmed.ncbi.nlm.nih.gov/12668699/

  3. Bakris GL et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. New England Journal of Medicine 2020;383(23):2219–2229.
    https://pubmed.ncbi.nlm.nih.gov/33264825/

  4. Filippatos G et al. Finerenone in Patients With CKD and T2D: A Meta-analysis of Cardiovascular and Kidney Outcomes Across the FIDELIO-DKD and FIGARO-DKD Studies. Circulation 2022;145(6):437–447.
    https://pubmed.ncbi.nlm.nih.gov/34871063/

  5. Monticone S et al. Spironolactone in the treatment of primary aldosteronism: a long-term study. Journal of Hypertension 2015;33(11):2260–2265.
    https://pubmed.ncbi.nlm.nih.gov/26352371/

10. Metabolic Effects & Insulin Resistance

  1. Sindelka G et al. Insulin action in primary hyperaldosteronism before and after surgical or pharmacological treatment. Experimental and Clinical Endocrinology & Diabetes 2000;108(1):21–25.
    https://pubmed.ncbi.nlm.nih.gov/10739083/

  2. Ronconi V et al. Serum adiponectin in primary aldosteronism: a cardioprotective adipokine. Journal of Clinical Endocrinology & Metabolism 2009;94(6):2044–2051.
    https://pubmed.ncbi.nlm.nih.gov/19293271/

11. Emerging Therapies: Aldosterone Synthase Inhibitors

  1. Amar L et al. Long-term cardiovascular outcomes in patients with primary aldosteronism. Hypertension 2010;55(5):1013–1020.
    https://pubmed.ncbi.nlm.nih.gov/20194309/

  2. Lim PO, Young WF, MacDonald TM. A review of the medical treatment of primary aldosteronism. Journal of Hypertension 2001;19(3):353–361.
    https://pubmed.ncbi.nlm.nih.gov/11288804/

12. QSP / Mathematical Modeling References

  1. Brown SA, Breit SN, Breen JD. Adaptation and regulation of hormone synthesis in adrenal cortex: mathematical modeling and experimental validation. American Journal of Physiology — Endocrinology and Metabolism 2004;287:E1169–E1177.
    https://pubmed.ncbi.nlm.nih.gov/15304374/

  2. Guyton AC, Coleman TG, Granger HJ. Circulation: overall regulation. Annual Review of Physiology 1972;34:13–46.
    https://pubmed.ncbi.nlm.nih.gov/4334846/

  3. Karaaslan F et al. Long-term mathematical model involving renal sympathetic nerve activity, arterial pressure, and sodium excretion. Annals of Biomedical Engineering 2005;33(11):1607–1630.
    https://pubmed.ncbi.nlm.nih.gov/16341926/

  4. Hallow KM et al. A quantitative systems physiology model of renal function and blood pressure regulation: model description and application to salt-sensitive hypertension. CPT: Pharmacometrics & Systems Pharmacology 2014;3(8):e130.
    https://pubmed.ncbi.nlm.nih.gov/25162017/

  5. Beard DA, Mescam M. Mechanisms of pressure-diuresis and pressure-natriuresis in Dahl salt-resistant and Dahl salt-sensitive rats. BMC Physiology 2012;12:6.
    https://pubmed.ncbi.nlm.nih.gov/22873438/

References compiled for the Primary Aldosteronism QSP model library. All links are to PubMed (NCBI) abstracts.