PDF(Pubmed)
Abstract：
Primary aldosteronism, characterized by the dysregulated production of aldosterone from 1 or both adrenal glands, is the most common endocrine cause of hypertension. It confers a high risk of cardiovascular, renal, and metabolic complications that can be ameliorated with targeted medical therapy or surgery. Diagnosis can be achieved with a positive screening test (elevated aldosterone to renin ratio) followed by confirmatory testing (saline, captopril, fludrocortisone, or oral salt challenges) and subtyping (adrenal imaging and adrenal vein sampling). However, the diagnostic pathway may be complicated by interfering medications, intraindividual variations, and concurrent autonomous cortisol secretion. Furthermore, once diagnosed, careful follow-up is needed to ensure that treatment targets are reached and adverse effects, or even recurrence, are promptly addressed. These challenges will be illustrated in a series of case studies drawn from our endocrine hypertension clinic. We will offer guidance on strategies to facilitate an accurate and timely diagnosis of primary aldosteronism together with a discussion of treatment targets which should be achieved for optimal patient outcomes.
摘要：
原发性醛固酮增多症,以1个或两个肾上腺的醛固酮产生失调为特征，是高血压最常见的内分泌原因。它赋予了心血管的高风险，肾,和代谢并发症可以通过靶向药物治疗或手术改善。诊断可以通过阳性筛查试验（醛固酮与肾素比率升高），然后进行确证试验（生理盐水，卡托普利,氟氢可的松,或口服盐激发）和亚型（肾上腺成像和肾上腺静脉采样）。然而,诊断途径可能因干扰药物而复杂化，个体差异，同时自主分泌皮质醇。此外，一旦确诊,需要仔细的随访，以确保达到治疗目标和不良反应，甚至复发，迅速解决。这些挑战将在我们的内分泌高血压诊所的一系列案例研究中得到说明。我们将提供有关策略的指导，以促进原发性醛固酮增多症的准确及时诊断，并讨论应实现的最佳患者预后的治疗目标。
