Tags

Type your tag names separated by a space and hit enter

Primary aldosteronism: diagnostic and treatment strategies.
Nat Clin Pract Nephrol. 2006 Apr; 2(4):198-208; quiz, 1 p following 230.NC

Abstract

Primary aldosteronism is caused by bilateral idiopathic hyperplasia in approximately two-thirds of cases and aldosterone-producing adenoma in one-third. Most patients with primary aldosteronism are normokalemic. In the clinical setting of normokalemic hypertension, patients who have resistant hypertension and hypertensive patients with a family history atypical for polygenic hypertension should be tested for primary aldosteronism. The ratio of plasma aldosterone concentration to plasma renin activity has been generally accepted as a first-line case-finding test. If a patient has an increased ratio, autonomous aldosterone production must be confirmed with an aldosterone suppression test. Once primary aldosteronism is confirmed, the subtype needs to be determined to guide treatment. The initial test in subtype evaluation is CT imaging of the adrenal glands. If surgical treatment is considered, adrenal vein sampling is the most accurate method for distinguishing between unilateral and bilateral adrenal aldosterone production. Optimal treatment for aldosterone-producing adenoma or unilateral hyperplasia is unilateral laparoscopic adrenalectomy. The idiopathic bilateral hyperplasia and glucocorticoid-remediable aldosteronism subtypes should be treated pharmacologically. All patients treated pharmacologically should receive a mineralocorticoid receptor antagonist, a drug type that has been shown to block the toxic effects of aldosterone on nonepithelial tissues.

Authors+Show Affiliations

Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16932426

Citation

Mattsson, Cecilia, and William F. Young. "Primary Aldosteronism: Diagnostic and Treatment Strategies." Nature Clinical Practice. Nephrology, vol. 2, no. 4, 2006, pp. 198-208; quiz, 1 p following 230.
Mattsson C, Young WF. Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol. 2006;2(4):198-208; quiz, 1 p following 230.
Mattsson, C., & Young, W. F. (2006). Primary aldosteronism: diagnostic and treatment strategies. Nature Clinical Practice. Nephrology, 2(4), 198-208; quiz, 1 p following 230.
Mattsson C, Young WF. Primary Aldosteronism: Diagnostic and Treatment Strategies. Nat Clin Pract Nephrol. 2006;2(4):198-208; quiz, 1 p following 230. PubMed PMID: 16932426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary aldosteronism: diagnostic and treatment strategies. AU - Mattsson,Cecilia, AU - Young,William F,Jr PY - 2005/10/12/received PY - 2006/02/10/accepted PY - 2006/8/26/pubmed PY - 2006/9/20/medline PY - 2006/8/26/entrez SP - 198-208; quiz, 1 p following 230 JF - Nature clinical practice. Nephrology JO - Nat Clin Pract Nephrol VL - 2 IS - 4 N2 - Primary aldosteronism is caused by bilateral idiopathic hyperplasia in approximately two-thirds of cases and aldosterone-producing adenoma in one-third. Most patients with primary aldosteronism are normokalemic. In the clinical setting of normokalemic hypertension, patients who have resistant hypertension and hypertensive patients with a family history atypical for polygenic hypertension should be tested for primary aldosteronism. The ratio of plasma aldosterone concentration to plasma renin activity has been generally accepted as a first-line case-finding test. If a patient has an increased ratio, autonomous aldosterone production must be confirmed with an aldosterone suppression test. Once primary aldosteronism is confirmed, the subtype needs to be determined to guide treatment. The initial test in subtype evaluation is CT imaging of the adrenal glands. If surgical treatment is considered, adrenal vein sampling is the most accurate method for distinguishing between unilateral and bilateral adrenal aldosterone production. Optimal treatment for aldosterone-producing adenoma or unilateral hyperplasia is unilateral laparoscopic adrenalectomy. The idiopathic bilateral hyperplasia and glucocorticoid-remediable aldosteronism subtypes should be treated pharmacologically. All patients treated pharmacologically should receive a mineralocorticoid receptor antagonist, a drug type that has been shown to block the toxic effects of aldosterone on nonepithelial tissues. SN - 1745-8323 UR - https://www.unboundmedicine.com/medline/citation/16932426/Primary_aldosteronism:_diagnostic_and_treatment_strategies_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=16932426.ui DB - PRIME DP - Unbound Medicine ER -