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Diagnosis and management of primary aldosteronism.
Arch Endocrinol Metab. 2017 May-Jun; 61(3):305-312.AE

Abstract

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.

Authors+Show Affiliations

Unidade de Suprarrenal, Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular - LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.Unidade de Suprarrenal, Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular - LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil. Instituto do Câncer do Estado de São Paulo (Icesp), FMUSP, São Paulo, SP, Brasil.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28699986

Citation

Vilela, Leticia A P., and Madson Q. Almeida. "Diagnosis and Management of Primary Aldosteronism." Archives of Endocrinology and Metabolism, vol. 61, no. 3, 2017, pp. 305-312.
Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. Arch Endocrinol Metab. 2017;61(3):305-312.
Vilela, L. A. P., & Almeida, M. Q. (2017). Diagnosis and management of primary aldosteronism. Archives of Endocrinology and Metabolism, 61(3), 305-312. https://doi.org/10.1590/2359-3997000000274
Vilela LAP, Almeida MQ. Diagnosis and Management of Primary Aldosteronism. Arch Endocrinol Metab. 2017 May-Jun;61(3):305-312. PubMed PMID: 28699986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and management of primary aldosteronism. AU - Vilela,Leticia A P, AU - Almeida,Madson Q, PY - 2016/09/11/received PY - 2017/05/04/accepted PY - 2017/7/13/entrez PY - 2017/7/13/pubmed PY - 2017/9/26/medline SP - 305 EP - 312 JF - Archives of endocrinology and metabolism JO - Arch Endocrinol Metab VL - 61 IS - 3 N2 - 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. SN - 2359-4292 UR - https://www.unboundmedicine.com/medline/citation/28699986/Diagnosis_and_management_of_primary_aldosteronism_ L2 - http://www.diseaseinfosearch.org/result/5936 DB - PRIME DP - Unbound Medicine ER -