[Primary hyperaldosteronism].
Primary hyperaldosteronism (PHA), autonomic secretion of aldosterone by the adrenal gland, is rare. PHA usually results in therapy-resistant hypertension and is often but not always accompanied by hypokalaemia. Common causes of PHA are an aldosterone-producing adenoma, idiopathic aldosterone hypersecretion, unilateral hyperplasia or a genetic variant: glucocorticoid-remediable aldosteronism (GRA). The diagnosis should be phased and first of all requires a biochemical confirmation of the presence of PHA. In PHA patients, plasma renin is invariably suppressed. Blood should be collected under standardised conditions while the patient is not using beta-blockers or centrally-acting antihypertensive medication. Patients with a suppressed plasma renin and an elevated plasma aldosterone concentration have PHA. In patients with a suppressed plasma renin and a high-normal plasma aldosterone concentration a confirming test should be performed in which PHA is diagnosed if aldosterone is not suppressed following volume expansion with sodium chloride. The cause of PHA is determined by means of a CT scan or MRI of the adrenal glands to find a unilateral adenoma. If the CT scan or MRI is normal, adrenal vein aldosterone sampling may be considered as a next step in order to demonstrate lateralisation of aldosterone production. The hypertension and hypokalaemia of all forms of PHA respond well to spironolactone therapy. In the case of a unilateral adenoma or unilateral hyperplasia, adrenalectomy is the treatment of choice. For GRA, dexamethasone in doses that reduce the corticotropin (ACTH) level is indicated.
van den Meiracker
A H
AH
Erasmus Medisch Centrum, afd. Inwendige Geneeskunde, Dr. Molewaterplein 40, 3015 GD Rotterdam. a.vandenmeiracker@erasmusmc.nl
Deinum
J
J
D000236:Adenoma / Q000150:complications; D000306:Adrenal Cortex Neoplasms / Q000150:complications; D000308:Adrenocortical Hyperfunction / Q000150:complications; D000450:Aldosterone / Q000032:analysis*; D000959:Antihypertensive Agents; D000075202:Contraindications; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006947:Hyperkalemia / Q000209:etiology; D006973:Hypertension / Q000209:etiology; D012083:Renin / Q000097:blood*
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin
Primair hyperaldosteronisme.