Affiliation:
1. Professor of Medicine, Mayo Medical School; Consultant, Division of Endocrinology, Metabolism, Nutrition and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905
Abstract
Abstract
Primary aldosteronism affects 5–13% of patients with hypertension. Patients with hypertension and hypokalemia and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with a plasma aldosterone concentration to plasma renin activity ratio. A high plasma aldosterone concentration to plasma renin activity ratio is a positive screening test result, a finding that warrants confirmatory testing. For those patients that want to pursue a surgical cure, the accurate distinction between the subtypes (unilateral vs. bilateral adrenal disease) of primary aldosteronism is a critical step. The subtype evaluation may require one or more tests, the first of which is imaging the adrenal glands with computed tomography, followed by selective use of adrenal venous sampling. Because of the deleterious cardiovascular effects of aldosterone, normalization of circulating aldosterone or aldosterone receptor blockade should be part of the management plan for all patients with primary aldosteronism. Unilateral laparoscopic adrenalectomy is an excellent treatment option for patients with unilateral aldosterone-producing adenoma. Bilateral idiopathic hyperaldosteronism should be treated medically. In addition, aldosterone-producing adenoma patients may be treated medically if the medical treatment includes mineralocorticoid receptor blockade.
Reference82 articles.
1. Presidential address. Part I, Painting background. Part II, Primary aldosteronism, a new clinical syndrome.;Conn;J Lab Clin Med,1955
2. A chimeric 11β-hydroxylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension.;Lifton;Nature,1992
3. New genetic insights in familial hyperaldosteronism.;Jackson;Ann N Y Acad Sci,2002
4. The incidence rate of phaeochromocytoma and Conn’s syndrome in Denmark, 1977–1981.;Andersen;J Hum Hypertens,1988
5. Evaluation of the hypertensive patient with emphasis on detecting curable causes.;Gifford Jr;Milbank Mem Fund Q,1969
Cited by
322 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献