Key result
Ambulatory microdialysis reveals pulsatile nocturnal hypersecretion of aldosterone and hybrid steroids in primary aldosteronism.
Why the study?
Alterations in the dynamics of aldosterone secretion in primary aldosteronism are not well captured by current diagnostic pathways, and the disease is often missed.
Cohort (n=60)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The most striking finding was that patients with primary aldosteronism exhibited marked nocturnal and early-morning pulsatile hypersecretion of aldosterone, with large interindividual variability, during a period when hormone measurements are rarely obtained in routine clinical practice. We also identified pronounced night-time elevations of the hybrid steroids 18-hydroxycortisol and 18-oxocortisol, particularly in patients with unilateral primary aldosteronism.”
“Traditionally, doctors have measured the hormone aldosterone in a single blood sample taken during the day. The new study shows that hormone secretion varies considerably throughout the 24-hour cycle, and that the greatest differences between healthy people and patients occur at night and in the early morning. This may explain why current diagnostic tests often fail to detect the condition.”
“By continuously monitoring hormones over 24 hours, we were able to reveal a previously hidden pattern of nocturnal hormone bursts. This gives us a much clearer understanding of the disease and could ultimately help doctors detect it earlier and treat patients more effectively. A more detailed mathematical and computational analysis of daily hormonal profiles could eventually also help uncover earlier and more subtle forms of the disease, opening new opportunities to improve outcomes for patients living with high blood pressure.”
Ambulatory dynamic hormone profiling reveals that primary aldosteronism is characterized by disrupted corticosteroid rhythms, particularly nocturnal hypersecretion, rather than persistent hormone elevation.
Primary aldosteronism affects 5 to 20% of the hypertensive population and is associated with increased cardiovascular and metabolic risk compared with primary hypertension. Alterations in the dynamics of aldosterone secretion are key, but these are not well captured by current diagnostic pathways, and the disease is often missed. In this proof-of-concept study, we used ambulatory microdialysis sampling to continuously monitor tissue corticosteroid dynamics in primary aldosteronism over 24 hours. In a cohort of 60 patients, we found pulsatile nocturnal hypersecretion of aldosterone and the hybrid steroids 18-hydroxycortisol and 18-oxocortisol with a preserved daily rhythm. This was most prominent in unilateral disease, with normalization after adrenalectomy. Our findings confirm that a key pathophysiological feature of primary aldosteronism is disruption of corticosteroid rhythms rather than persistent elevation of hormones. We show that ambulatory dynamic hormone profiling is a viable technique that offers substantially more information than current diagnostic approaches relying on single–time point hormone measurements. In the future, this offers the opportunity to investigate more subtle dynamic phenotypes and potentially earlier detection of disease.
No takes yet. Share an insight, caveat, or question.
Grytaas et al. (2026) conducted a cohort in Primary aldosteronism (n=60). Ambulatory microdialysis sampling was evaluated on Tissue corticosteroid dynamics. Ambulatory microdialysis sampling over 24 hours revealed pulsatile nocturnal hypersecretion of aldosterone and hybrid steroids in 60 patients with primary aldosteronism.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: