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

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.