Aldosteronomas--state of the art.
Primary aldosteronism (PA) is the most common cause of secondary hypertension in nonsmokers. Widespread screening of unselected hypertensives has identified PA in as many as 15% of patients. With such screening efforts using the PAC/PRA ratio and PAC, the widespread prevalence of the disease has become apparent while the relative percentage of APA has decreased. PA is confirmed by demonstrating lack of aldosterone suppressibility with sodium loading. Subtype evaluation is best achieved with high resolution CT scanning and AVS in the appropriate setting. In patients with PA and a unilateral source of aldosterone excess, laparoscopic adrenalectomy is the treatment of choice with excellent outcomes and low morbidity as compared with older open approaches. Patients with IHA, or those not amenable or agreeable to surgery, are best managed with a MR antagonist.
McKenzie
Travis J
TJ
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Lillegard
Joseph B
JB
Young
William F
WF
Thompson
Geoffrey B
GB
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006973:Hypertension / Q000209:etiology; D014057:Tomography, X-Ray Computed