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Primary hyperaldosteronism in Acute Central Serous Chorioretinopathy: a real need for screening?

  • Retinal Disorders
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Abstract

Purpose

Central Serous Chorioretinopathy (CSCR) is a prevalent ocular disease classified in the pachychoroidal spectrum with an elevated morbidity. Although the pathogenesis is yet unclear, mineralocorticoid-mediated pathways seem to be implicated. Primary hyperaldosteronism (PA) is a relatively frequent, albeit underdiagnosed, cause of hypertension, and has a specific therapy. A previous study assessed the prevalence of CSCR-like signs in a cohort of patients diagnosed with PA and found signs in seven out of thirteen PA patients. The present study aims to study the contrary, screening for PA in a cohort of acute CSCR patients.

Methods

Between March 2017 and September 2018 all patients with acute CSCR were systematically referred to Endocrinology Department after complete ophthalmic evaluation was performed with visual acuity, spectral domain optical coherence tomography, fundus autofluorescence, fluorescein and indocyanine green angiography. The method applied for detection of PA was the 2-h 25 mg captopril challenge test (CCT).

Results

Of the nineteen patients screened, two of them had a CCT positive for PA (2-h plasma aldosterone/renin ratio > 50 and/or an aldosterone level of 130 pg/ml or higher), and were treated with mineralocorticoid receptor antagonists (MRA). No ophthalmic pattern was identified in them in terms of time to resolution, recurrences or features of the acute episode. The only differential feature in the fundus of PA patients was pathological arteriovenous crossings (AVC) as well as elevated BP levels.

Conclusion

a high incidence of PA was found among acute CSCR patients. This preliminary study suggests a need for screening for PA in hypertensive CSCR patients in real clinical practice.

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Authors and Affiliations

  1. Hospital Clínico San Carlos. C. Profesor Martín Lagos S.N, 28040, Madrid, Spain

    A. Valverde-Megías, E. Montolío-Marzo, I. Runkle & J. I. Fernández-Vigo

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  1. A. Valverde-Megías
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  2. E. Montolío-Marzo
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  3. I. Runkle
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  4. J. I. Fernández-Vigo
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Corresponding author

Correspondence to A. Valverde-Megías.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Hospital Clínico San Carlos Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Ethical approval

Hospital Clínico San Carlos Ethics Committee approved this study.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Valverde-Megías, A., Montolío-Marzo, E., Runkle, I. et al. Primary hyperaldosteronism in Acute Central Serous Chorioretinopathy: a real need for screening?. Graefes Arch Clin Exp Ophthalmol 261, 3193–3200 (2023). https://doi.org/10.1007/s00417-023-06185-z

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  • DOI: https://doi.org/10.1007/s00417-023-06185-z

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