Primary aldosteronism: part II: subtype differentiation and treatment.
After discussing in Part I (Rossi et al, J Nephrol. 2008;21:447-454) the screening strategy to identify the hypertensive patients with primary aldosteronism (PA), we report here an update on the methodology for the further diagnostic work-up and treatment of PA patients. The most common forms of PA are aldosterone-producing adenoma (APA) and adrenocortical hyperplasia (BAH), which are unilateral or bilateral sources of aldosterone excess secretion, respectively. Since APA needs a surgical approach, in contrast to BAH which requires medical treatment, it is crucial to clearly delineate a diagnostic work-up aimed at discriminating the 2 forms. Clinical usefulness and accuracy of adrenal vein sampling, imaging tests (e.g., computed tomography and magnetic resonance) and mineralocorticoid adrenocortical scintigraphy are discussed in detail.
Rossi
G P
GP
Department of Clinical and Experimental Medicine, Clinica Medica 4, University of Padua, Padua - Italy. gianpaolo.rossi@unipd.it
Seccia
T M
TM
Pessina
A C
AC
D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging; D000315:Adrenalectomy / Q000379:methods*; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014680:Veins / Q000473:pathology
D000451:Mineralocorticoid Receptor Antagonists