Hypertension is a leading risk factor for death and disability globally. Close to 6 million adults (34%) in Australia are affected; 4.1 million of them have uncontrolled or untreated hypertension. To improve blood pressure control and reduce morbidity/mortality, we need to address the under-diagnosis of secondary causes, in particular an eminently treatable and potentially curable cause – primary aldosteronism (PA), or Conn’s syndrome. PA is caused by excessive aldosterone production from either one or both adrenal glands.  Specific blockade of aldosterone action with mineralocorticoid receptor antagonists offers highly effective and targeted treatment, while a unilateral aldosterone-producing adrenal adenoma can be surgically removed.

Whilst previously taught as rare, PA has been found to affect 5-10% of hypertensive patients in primary care and up to 30% of patients with resistant hypertension.  However, PA is not routinely screened for.  Half a million hypertensive Australians may be missing out on targeted treatment or cure for their hypertension. A missed or delayed diagnosis is detrimental.  Simply controlling blood pressure is not enough; PA patients suffer excessive coronary artery disease, stroke, atrial fibrillation and chronic kidney disease compared to patients with essential hypertension due to the effects of aldosterone excess. These complications can be prevented with early diagnosis and targeted treatment.  But how early is early enough? Recent literature suggests that PA exists on a continuum such that only the tip of the iceberg is being detected. The age from which the continuum begins is unknown.  After screening, the diagnosis of PA and accurate subtyping remains challenging, time-consuming and costly, involving hospital stays.

Our goal is to diagnose every case of primary aldosteronism, in all communities including the disadvantaged populations, in the most time-efficient and cost-effective manner and offer efficacious targeted management with minimal side effects.

We established the Endocrine Hypertension Service in July 2017 for the purpose of integrating research with clinical service.  We collaborate with clinicians in a range of specialties (general practice, cardiology, nephrology, stroke, respiratory medicine, radiology, chemical pathology, endocrine surgery, anatomical pathology) and researchers in various disciplines (molecular biology, genetics, physiology, cardiovascular endocrinology, health economics, biostatistics), to increase the scope and reach of our research.  We also collaborate nationally and internationally with dedicated hypertension research groups to collectively advance this field of work.

Research Projects

Our current projects include the evaluation of

• Prevalence of primary aldosteronism in a range of conditions that co-exist with hypertension (eg. diabetes, atrial fibrillation, stroke, chronic kidney disease, etc);
• Implementation of screening for primary aldosteronism in primary and tertiary care;
• Cost-effectiveness of screening and diagnosis, and modifiers of cost;
• Interaction between aldosterone excess and non-cardiovascular systems (eg. bone, muscle, parathyroid, brain etc)
• Development and validation of diagnostic tests/protocols, including novel biomarkers, for screening and diagnosing the full spectrum of primary aldosteronism;
• Pathogenesis and genetic basis for various subtypes of primary aldosteronism;
• Patient choices and patient-reported outcome measures in the diagnosis and management of primary aldosteronism;
• Effectiveness of different treatment options for primary aldosteronism in clinical trials.

Our team values equity, respect and integrity. We are passionate about achieving our goal whilst holding ourselves accountable to these values.  If you are looking for a project, come and talk to us to work out if we are the right fit for you and discover which topic excites you the most!  We can accommodate BMedSci, Honours, Masters or PhD students.  If you would like to learn more about primary aldosteronism, drop us a line and read more about it here.

Research Group

• Dr Jimmy Shen, Senior Research Scientist
• Peta Nuttall, Research Support Staff
• Nikshay Karthigan, PhD Student
• Dr Renata Libianto, PhD Student

Selected publications

• Wang K*, Hu J*, Yang J*, Song Y, Fuller PJ, Hashimura H, He W, Feng , Cheng Q, Du Z, Wang Z, Ma L, Yang S, Li Q (2020) Development and validation of criteria for sparing confirmatory tests in diagnosing primary aldosteronism. Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 7, July 2020, https://doi.org/10.1210/clinem/dgaa282 (* equal first authors).

• Fuller PJ, Yao YZ, Yang J, Young MJ (2020) Structural Determinants of Activation of the Mineralocorticoid Receptor: an Evolutionary Perspective. Journal of Human Hypertension (2020). https://doi.org/10.1038/s41371-020-0360-2.

• Chee NYN, Abdul-Wahab A, Libianto R, Gwini SM, Doery JCG, Choy KW, Chong W, Lau KK, Lam Q, MacIsaac RJ, Chiang C, Shen J, Young MJ, Fuller PJ, Yang J (2020) Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization. Clinical Endocrinology 2020 May 13. doi: 10.1111/cen.14220.

• Lim YY, Libianto R, Shen J, Young MJ, Fuller PJ, Yang J (2020) Impact of Victoria’s first dedicated Endocrine Hypertension Service on the pattern of primary aldosteronism diagnoses. Internal Medicine Journal 2020 May 3. doi: 10.1111/imj.14879.

• Solanki P, Gwini SM, Doery JCG, Choy KW, Shen J, Young MJ, Fuller PJ, Yang J (2020) Age and sex-specific reference ranges are needed for the Aldosterone/Renin Ratio. Clinical Endocrinology 2020 April 19. https://doi.org/10.1111/cen.14199.

• Libianto R, Fuller PJ, Young M, Yang J (2020) Primary aldosteronism is a public health issue: challenges and opportunities. Journal of Human Hypertension 34, 478–486. https://doi.org/10.1038/s41371-020-0336-2.

• Xu Z*, Yang J*, Song Y, Luo T, Hu J, Cheng Q, Ma L, Luo R, Fuller PJ, Cai J, Yang S, Li Q (2020) Prevalence, characteristics and outcomes of primary aldosteronism in newly diagnosed hypertensives in China. Journal of the American College of Cardiologists Volume 75, Issue 16, April 2020. DOI: 10.1016/j.jacc.2020.02.052 (* equal first authors).

• Gurgenci T, Geraghty S, Wolley M, Yang J (2020) Screening for primary aldosteronism: how to adjust existing anti-hypertensive treatment to avoid diagnostic errors. The Australian Journal of General Practice. Mar;49(3):127-131. doi: 10.31128/AJGP-07-19-4995.

• Yang J, Fuller P (2020) Simplifying the Diagnosis of Primary Aldosteronism. Journal of Clinical Endocrinology and Metabolism. Apr 1;105(4). pii: dgz202. doi: 10.1210/clinem/dgz202.

• Rossi GP, Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J Jr, Naruse M, Deinum J, Schultze Kool L, Kocjan T, Negro A, Rossi E, Kline G, Tanabe A, Satoh F, Christian Rump L, Vonend O, Willenberg HS, Fuller PJ, Yang J, Chee NYN, Magill SB, Shafigullina Z, Quinkler M, Oliveras A, Dun Wu K, Wu VC, Kratka Z, Barbiero G, Battistel M, Chang CC, Vanderriele PE, Pessina AC (2019) Clinical Outcomes of 1625 Patients With Primary Aldosteronism Subtyped With Adrenal Vein Sampling. Hypertension. doi: 10.1161/HYPERTENSIONAHA.119.13463.

• Yang J, Fuller PJ and Stowasser M (2018) Is it time to screen all hypertensives for primary aldosteronism? Medical Journal of Australia. Jul 16;209(2):57-59. – co-authored with Prof Michael Stowasser, an international doyen of PA research.

• Hashimura H, Shen J, Fuller PJ, Chee NYN, Doery JCG, Chong W, Choy KW, Gwini S, Yang J (2018) Saline suppression test parameters may predict bilateral subtypes of primary aldosteronism. Clinical Endocrinology (Oxf). 2018 Jun 6. doi: 10.1111/cen.13757.

• Yang J, Shen J and Fuller PJ (2017) A practical approach to diagnosing endocrine hypertension. Nephrology. 22(9):663-677.

• Yang J, Safi R, Chang C, Fuller PJ, McDonnell DP, Clyne CD and Young MJ (2011) Identification of ligand-specific peptide antagonists of the mineralocorticoid receptor using phage display. Molecular Endocrinology. 25(1):32-43.

• Yang J, Morag J Young. (2009) The mineralocorticoid receptor and its coregulators. Journal of Molecular Endocrinology. 43(2):53-64.