{
  "abstract": "Objectives Systemic lupus erythematosus (SLE) is a systemic autoimmune disease in which hypertension and cardiovascular disease are prevalent; yet the underlying mechanisms are not fully understood. Primary aldosteronism (PA), a common but underdiagnosed cause of hypertension, may contribute to this cardiovascular and hypertensive burden in SLE. The Aldosterone and Renin in SLE (ADORE-SLE) study aims to prospectively assess the prevalence of PA in SLE.Methods Adults with SLE attending the Monash Health Lupus Clinic (Melbourne, Australia) underwent screening with the plasma aldosterone-to-renin ratio (ARR). Patients with elevated ARR (> 70 pmol/mU) suggesting probable PA were referred to the Endocrine Hypertension Clinic for further evaluation. Clinical data, medications, and comorbidities were recorded prospectively.Results Amongst the 73 patients with SLE recruited (median (IQR) age 50 (39-59) years, 92% female), ARR results were available for 59 (80.8%). Of the 34 participants with co-existing hypertension, four (11.8%) had probable PA. Data collection is ongoing.We report on the first patient in this cohort to have confirmed PA, based on an abnormal aldosterone suppression test. She is a 67-year-old woman with rhupus (SLE diagnosed in 2018; and rheumatoid arthritis diagnosed in 2019) managed with weekly methotrexate and low-dose prednisolone as required. Despite previously normal blood pressure, her ARR in 2022 was elevated (111 pmol/mU; aldosterone 321 pmol/L; renin 2.9 mU/L). Hypertension developed in 2024 (142/76 mmHg), and a saline suppression test in 2025 confirmed PA. Treatment with spironolactone (25mg daily, later increased to 37.5mg) is ongoing, with partial BP control achieved.Conclusions We report the first case of PA in the ADORE-SLE study, highlighting the variable presentation and low threshold for clinical suspicion required to diagnose this treatable cause of hypertension. The true prevalence of PA among people with SLE and concurrent hypertension remains uncertain, but our preliminary data suggest it may be at least 10%, warranting further investigation. Establishing a streamlined diagnostic pathway following PA screening within rheumatology clinics could enable earlier identification and improved cardiovascular outcomes in this high-risk population.",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine, Monash University, Clayton, Melbourne, Australia"
      ],
      "name": "Chrislyn Ng"
    },
    {
      "affiliations": [
        "Department of Medicine, Monash University, Clayton, Melbourne, Australia"
      ],
      "name": "Grace Feng"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia"
      ],
      "name": "Celine Shi"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Kathryn Connelly"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Laura E Eades"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Vera Golder"
    },
    {
      "affiliations": [
        "Department of Nephrology, Monash University, Clayton, Melbourne, Australia"
      ],
      "name": "Joanna Kent"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Emily Lin"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Kristy Yap"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Eric Morand"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia",
        "Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Alberta Y Hoi"
    },
    {
      "affiliations": [
        "Department of Medicine, Monash University, Clayton, Melbourne, Australia",
        "Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Melbourne, Australia",
        "Department of Endocrinology, Monash Health, Clayton, Melbourne, Australia"
      ],
      "name": "Jun Yang"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia"
      ],
      "name": "Fabien B Vincent"
    }
  ],
  "title": "PO:04:105 Primary aldosteronism in lupus: a case highlighting autoimmune-endocrine crossroads",
  "uid": "29ccd367-23b8-5295-af44-74dc7730580c"
}