Abstract
Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of the hypertensive population. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass. The most advocated screening test at present is the aldosterone-to-renin ratio, which has a high sensitivity but low specificity. The specificity increases if patients with low aldosterone concentrations are excluded. Published cut-off values vary depending on the hormone assay and the investigated population. Before screening, antihypertensive treatment, especially aldosterone antagonists and beta-blockers, should be discontinued. A pathologic result requires additional work up to prove mineralocorticoid excess. Subtype differentiation is performed by adrenal venous sampling combined with imaging (CT or MRI). One-third of cases are due to aldosterone-producing adenomas, for which the preferred treatment is laparoscopic adrenalectomy. Bilateral adrenal hyperplasia (idiopathic aldosteronism) underlies two-thirds of cases and requires treatment with aldosterone antagonists. Treatment is started with low doses of spironolactone (25-50 mg once daily), which often results in substantial improvements in hypertension.
Item Type: | Journal article |
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Keywords: | aldosterone, Conn's syndrome, primary aldosteronism, renin, secondary hypertension |
Faculties: | Medicine Medicine > Medical Center of the University of Munich > Medical Clinic and Outpatient Clinic IV (Endocrinology, nephrology, other sections) |
Subjects: | 600 Technology > 610 Medicine and health |
ISSN: | 1745-8374; 1759-5037 |
Language: | English |
Item ID: | 40768 |
Date Deposited: | 13. Oct 2017, 06:02 |
Last Modified: | 04. Nov 2020, 13:17 |