Diagnosis and management of primary aldosteronism
| العنوان: | Diagnosis and management of primary aldosteronism |
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| المؤلفون: | Leticia A P Vilela, Madson Q. Almeida |
| المصدر: | Archives of Endocrinology and Metabolism, Volume: 61, Issue: 3, Pages: 305-312, Published: JUN 2017 Archives of Endocrinology and Metabolism v.61 n.3 2017 Arquivos de Endocrinologia e Metabolismo Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) instacron:SBEM Archives of Endocrinology and Metabolism, Vol 61, Iss 3, Pp 305-312 |
| بيانات النشر: | Archives of Endocrinology and Metabolism, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | medicine.medical_specialty, diagnosis, medicine.drug_class, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Urology, lcsh:Medicine, Secondary hypertension, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, lcsh:Diseases of the endocrine glands. Clinical endocrinology, Plasma renin activity, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Primary aldosteronism, Adrenal Glands, Hyperaldosteronism, medicine, Humans, Mineralocorticoid Receptor Antagonists, lcsh:RC648-665, aldosterone, Aldosterone, business.industry, Adrenalectomy, lcsh:R, resistant hypertension, medicine.disease, Eplerenone, renin, chemistry, Mineralocorticoid, Hypertension, Spironolactone, Tomography, X-Ray Computed, business, medicine.drug |
| الوصف: | Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a “gold standard” confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment. |
| وصف الملف: | text/html |
| تدمد: | 2359-3997 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c68c957104cb243e75c542068d32e66e https://doi.org/10.1590/2359-3997000000274 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....c68c957104cb243e75c542068d32e66e |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 23593997 |
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