Treatment of primary aldosteronism

被引:23
作者
Quinkler, Marcus [2 ]
Stewart, Paul M. [1 ]
机构
[1] Univ Birmingham, Queen Elizabeth Hosp, Div Med Sci, Inst Biomed Res, Birmingham B15 2TH, W Midlands, England
[2] Charite, D-10117 Berlin, Germany
关键词
primary aldosteronism; mineralocorticoid receptor; adrenalectomy; spironolactone; eplerenone; conn's adenoma; GLUCOCORTICOID-REMEDIABLE ALDOSTERONISM; CONVERTING ENZYME-INHIBITOR; CALCIUM-CHANNEL BLOCKADE; INTIMA-MEDIA THICKNESS; PLASMA-RENIN ACTIVITY; ESSENTIAL-HYPERTENSION; PRIMARY HYPERALDOSTERONISM; RESISTANT HYPERTENSION; HYPER-ALDOSTERONISM; BLOOD-PRESSURE;
D O I
10.1016/j.beem.2010.10.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The prevalence of primary hyperaldosteronism approaches 10% of all hypertensive patients, and besides efficient diagnostic procedures, effective treatment is of increasing importance to reverse increased morbidity and mortality. Aldosterone-producing adenoma and unilateral adrenal hyperplasia are amenable to cure by endoscopic adrenalectomy. Bilateral adrenal hyperplasia (micro- or macronodular), which comprises two-thirds of primary hyperaldosteronism, is treated primarily by mineralocorticoid receptor antagonists (starting dose 12.5-25 mg/day spironolactone with titration up to 100 mg/day, alternatively 50-100 mg/day eplerenone). If blood pressure is not normalised by this first-line treatment, additional treatment with potassium-sparing diuretics (amiloride or triamterene) or calcium channel antagonists is necessary. The start of medication should be closely monitored by serum electrolyte and creatinine controls. (C) 2010 Elsevier Ltd. All rights reserved.
引用
收藏
页码:923 / 932
页数:10
相关论文
共 97 条
[41]   A CHIMERIC 11-BETA-HYDROXYLASE ALDOSTERONE SYNTHASE GENE CAUSES GLUCOCORTICOID-REMEDIABLE ALDOSTERONISM AND HUMAN HYPERTENSION [J].
LIFTON, RP ;
DLUHY, RG ;
POWERS, M ;
RICH, GM ;
COOK, S ;
ULICK, S ;
LALOUEL, JM .
NATURE, 1992, 355 (6357) :262-265
[42]   High prevalence of primary aldosteronism in the Tayside hypertension clinic population [J].
Lim, PO ;
Dow, E ;
Brennan, G ;
Jung, RT ;
MacDonald, TM .
JOURNAL OF HUMAN HYPERTENSION, 2000, 14 (05) :311-315
[43]   A review of the medical treatment of primary aldosteronism [J].
Lim, PO ;
Young, WF ;
MacDonald, TM .
JOURNAL OF HYPERTENSION, 2001, 19 (03) :353-361
[44]  
Lim PO, 1999, BRIT J CLIN PHARMACO, V48, P756
[45]   Primary aldosteronism - Results of surgical treatment [J].
Lo, CY ;
Tam, PC ;
Kung, AWC ;
Lam, KSL ;
Wong, J .
ANNALS OF SURGERY, 1996, 224 (02) :125-130
[46]   Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore [J].
Loh, KC ;
Koay, ES ;
Khaw, MC ;
Emmanuel, SC ;
Young, WF .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2000, 85 (08) :2854-2859
[47]   EFFECT OF ANGIOTENSIN-II AND CONVERTING ENZYME-INHIBITOR (CAPTOPRIL) ON BLOOD-PRESSURE, PLASMA-RENIN ACTIVITY AND ALDOSTERONE IN PRIMARY ALDOSTERONISM [J].
MANTERO, F ;
FALLO, F ;
OPOCHER, G ;
ARMANINI, D ;
BOSCARO, M ;
SCARONI, C .
CLINICAL SCIENCE, 1981, 61 :S289-S293
[48]   Aldosterone and end-organ damage [J].
Marney, Annis M. ;
Brown, Nancy J. .
CLINICAL SCIENCE, 2007, 113 (5-6) :267-278
[49]   Long-term follow-up after adrenalectomy for primary aldosteronism [J].
Meyer, A ;
Brabant, G ;
Behrend, M .
WORLD JOURNAL OF SURGERY, 2005, 29 (02) :155-159
[50]   Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism [J].
Milliez, P ;
Girerd, X ;
Plouin, PF ;
Blacher, J ;
Safar, ME ;
Mourad, JJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (08) :1243-1248