Primary Aldosteronism

Июль 31, 2022

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Primary Aldosteronism

Содержание

2. Adrenal Steroids MK GK Andro KA
3. Renin-Angiotensin-Aldosterone System
4. Ion Transport in Collecting Tubule Principal Cells
5. Nonsuppressible (primary) hypersecretion of aldosterone is an underdiagnosed cause of hypertension. 1-2% in unselected patients with
6. Resistant hypertension - failure to achieve goal blood pressure (BP) despite adherence to an appropriate three-drug
8. Clinical Features of Primary Aldosteronism Hypertension Hypokalemia only 40-50% Lack of edema Metabolic alkalosis Mild hypernatremia,
9. Subtypes of Primary Aldosteronism Adenoma Hyperplasia
11. Screening for Primary Aldosteronism severe hypertension (>160/100 mmHg) or drug-resistant hypertension HTN and spontaneous or diuretic-induced
12. Screening (cont.) Plasma Aldosterone-to-Renin ratio mid-morning, after the patient has been up for at least 2
13. Confirmation of the Diagnosis Oral sodium loading 24-h urine Na excretion >200 meq Urine Aldo excretion>12
15. Imaging CT scan MRI Adrenal venous sampling Iodocholesterol scintigraphy
16. Adenoma vs. Bilateral Hyperplasia
17. Diagnosis of Primary Aldosteronism Lab. Tests Adrenal CT Scan Unilateral Hypodense Nodule 1-2 sm Normal, Micronodular,
18. Adrenal Venous Sampling
19. Treatment HTN is improved in all and is cured in 35-60% of pt.
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Adrenal Steroids
MK
GK
Andro
KA

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Renin-Angiotensin-Aldosterone System

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Ion Transport in Collecting Tubule Principal Cells

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Nonsuppressible (primary) hypersecretion of aldosterone is an underdiagnosed cause of

hypertension.
1-2% in unselected patients with hypertension.
10-20% in patients with resistant hypertension.
1% of adrenal incidentaloma = aldosteronoma.

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Resistant hypertension - failure to achieve goal blood pressure (BP) despite

adherence to an appropriate three-drug regimen including a diuretic.
Refractory hypertension – failure to control the BP even with maximal medical therapy (four or more drugs with complementary mechanisms given at maximal tolerated doses) under the care of a hypertension specialist.

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Clinical Features of Primary Aldosteronism
Hypertension
Hypokalemia only 40-50%
Lack of edema
Metabolic alkalosis
Mild hypernatremia,

hypomagnesemia
↑ GFR, polyuria, proteinuria, CRF
Muscle weakness&cramps (hypokalemia less than 2.5 meq/L)
LVH, MI, CVA, AF

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Subtypes of Primary Aldosteronism
Adenoma
Hyperplasia

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Screening for Primary Aldosteronism
severe hypertension (>160/100 mmHg) or drug-resistant hypertension
HTN

and spontaneous or diuretic-induced hypokalemia
hypertension with adrenal incidentaloma
hypertension and a family history of early onset hypertension or CVA at a young age (<40 years)
case detection for all hypertensive first-degree relatives of patients with PA is recommend

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Screening (cont.)
Plasma Aldosterone-to-Renin ratio
mid-morning, after the patient has been up for

at least 2 hours and seated for 5-15 minutes
have to be withdrawn for at least 4 weeks:
Spironolactone, eplerenone, amiloride, and triamterene
Potassium-wasting diuretics
Confectionary licorice, chewing tobacco
Results:
PRA↓
PAC ≥15 ng/dL (416 pmol/L)
PAC/PRA ≥20

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