Diagnosis and Management of Primary Aldosteronism

Vin-Cent Wu ； Chia-Ter Chao ； Chin-Chi Kuo ； Yen-Hung Lin ； S. Jeff Chueh ； Kwan-Dun Wu

《Acta Nephrologica》 26卷3期 (2012/09) Pp. 111-120

https://doi.org/10.6221/AN.2012005

並列摘要

Primary aldosteronism (PA or Conn' syndrome) is the most common secondary form of arterial hypertension, with an estimated prevalence ranging between 6% and 20% in patients with resistant hypertension. The use of aldosterone-renin ratio (ARR) for screening contributes to the increased diagnostic rate of this disease. Diagnosis of primary aldosteronism consists of an initial screening test and subsequent confirmatory tests. A prompt recognition of this disease and early institution of treatment is vital to protecting patients from aldosterone-related blood pressure control and attenuated cardiovascular events. Aldosterone-producing adenoma and bilateral adrenal hyperplasia (micro-or macro-nodular) are the two main subtypes, constituting more than 90% of primary aldosteronism cases.Aldosterone-producing adenoma (APA) is typically managed with laparoscopic adrenalectomy. Idiopathic hyperaldosteronism (IHA) is amenable to medical therapy with mineralocorticoid receptor antagonists. Adrenal image is not accurate for distinguishing between an APA and IHA. Adrenal venous sampling (AVS) is therefore essential for selecting the appropriate therapy for patients with a high probability of PA who require surgical treatment. Short-term treatment outcome is determined by factors such as pre-operative blood pressure level and hypertension duration, but evidence on long-term outcome and survival after therapy is still lacking.The purpose of this review is to provide up-to-date information on the etiology as well as strategies for the subtype lateralization and the management of PA.

並列關鍵字

Aldosteronism ； adenoma ； hyperplasia ； hypertension

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