Central serous chorioretinopathy in primary hyperaldosteronism

PURPOSE: To describe ophthalmological characteristics of 13 patients with primary hyperaldosteronism (PA). METHODS: Cross-sectional study. All patients underwent extensive ophthalmological examination. RESULTS: Thirteen PA patients (9 male, 4 female) were diagnosed with arterial hypertension for 11.0 ± 11.2 years. Ophthalmological imaging revealed macular serous subretinal fluid (SRF) on optical coherence tomography in 2 patients (15 %). In one of these patients, bilateral chronic central serous chorioretinopathy (CSC) with polypoidal choroidal neovasculopathy was diagnosed, which was effectively treated with full-dose photodynamic therapy. In the other patient with SRF and bilateral diffuse hyperfluorescent areas on fluorescein angiography, the SRF had decreased spontaneously after 6 weeks of follow-up. In 5 of the remaining patients (38 %), retinal pigment epithelium alterations resembling findings characteristic for CSC were seen on multimodal imaging. The mean subfoveal choroidal thickness was 290.2 ± 65.0 μm. CONCLUSIONS: Retinal abnormalities resembling (subclinical) CSC are common in patients with PA. These findings indicate that mineralocorticoid-mediated pathways are involved in the pathogenesis of CSC. In CSC patients with hypertension of unknown origin, a diagnosis of PA should be considered.