Diagnosis and management of primary aldosteronism: an updated review

Chao, Chia-Ter, Wu, Vin-Cent, Kuo, Chin-Chi, Lin, Yen-Hung, Chang, Chin-Chen, Chueh, S. Jeff, Wu, Kwan-Dun, Pimenta, Eduardo and Stowasser, Michael (2013) Diagnosis and management of primary aldosteronism: an updated review. Annals of Medicine, 45 4: 375-383. doi:10.3109/07853890.2013.785234


Author Chao, Chia-Ter
Wu, Vin-Cent
Kuo, Chin-Chi
Lin, Yen-Hung
Chang, Chin-Chen
Chueh, S. Jeff
Wu, Kwan-Dun
Pimenta, Eduardo
Stowasser, Michael
Title Diagnosis and management of primary aldosteronism: an updated review
Journal name Annals of Medicine   Check publisher's open access policy
ISSN 0785-3890
1365-2060
Publication date 2013-06
Sub-type Critical review of research, literature review, critical commentary
DOI 10.3109/07853890.2013.785234
Volume 45
Issue 4
Start page 375
End page 383
Total pages 9
Place of publication London, United Kingdom
Publisher Informa Healthcare
Collection year 2014
Language eng
Abstract Primary aldosteronism (PA) is the most common secondary form of arterial hypertension, with a particularly high prevalence among patients with resistant hypertension. Aldosterone has been found to be associated with cardiovascular toxicity. Prolonged aldosteronism leads to higher incidence of cardiac events, glomerular hyperfiltration, and potentially bone/metabolic sequels. The wider application of aldosterone/renin ratio as screening test has substantially contributed to increasing diagnosis of PA. Diagnosis of PA consists of two phases: screening and confirmatory testing. Adrenal imaging is often inaccurate for differentiation between an adenoma and hyperplasia, and adrenal venous sampling is essential for selecting the appropriate treatment modality. The etiologies of PA have two main subtypes: unilateral (aldosterone-producing adenoma) and bilateral (micro- or macronodular hyperplasia). Aldosterone-producing adenoma is typically managed with unilateral adrenalectomy, while bilateral adrenal hyperplasia is amenable to pharmacological approaches using mineralocorticoid antagonists. Short-term treatment outcome following surgery is determined by factors such as preoperative blood pressure level and hypertension duration, but evidence regarding long-term treatment outcome is still lacking. However, directed treatments comprising of unilateral adrenalectomy or mineralocorticoid antagonists still potentially reduce the toxicities of aldosterone. Utilizing a physician-centered approach, we intend to provide up-dated information on the etiology, diagnosis, and the management of PA.
Keyword Adenoma
Aldosteronism
Hyperplasia
Hypertension
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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