Primary aldosteronism and a Texas two-step
Tóm tắt
Primary aldosteronism is unquestionably the most common secondary cause of hypertension, and effective approaches to diagnosis and targeted treatments exist. Even the most conservative estimates of the prevalence of primary aldosteronism, however, indicate that the condition is grossly underdiagnosed. Part of the reason why diagnosis and treatment lag far behind is the lack of expertise, even among endocrinologists and hypertension specialists, in the approach to the patient with possible primary aldosteronism. We will never make an impression on this important problem unless general internists and primary care physicians actively participate in the screening and referral process. A healthcare delivery team need not fear an overwhelming and fruitless battle with an intractable conundrum if a practical and staged approach to workup and treatment is taken. This review discusses the approach we have taken in Dallas, a strategy of targeted screening, referral for positive screens, and individualized management.
Tài liệu tham khảo
Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89:1045–50.
Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3266–81.
Nishizaka MK, Pratt-Ubunama M, Zaman MA, Cofield S, Calhoun DA. Validity of plasma aldosterone-to-renin activity ratio in African American and white subjects with resistant hypertension. Am J Hypertens. 2005;18:805–12.
Montori VM, Schwartz GL, Chapman AB, Boerwinkle E, Turner ST. Validity of the aldosterone-renin ratio used to screen for primary aldosteronism. Mayo Clin Proc. 2001;76:877–82.
Bravo EL, Tarazi RC, Dustan HP, Fouad FM, Textor SC, Gifford RW, et al. The changing clinical spectrum of primary aldosteronism. Am J Med. 1983;74:641–51.
Irony I, Kater CE, Biglieri EG, Shackleton CH. Correctable subsets of primary aldosteronism. Primary adrenal hyperplasia and renin responsive adenoma. Am J Hypertens. 1990;3:576–82.
Catena C, Colussi GL, Lapenna R, Nadalini E, Chiuch A, Gianfanga P, et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid receptor antagonists in patients with primary aldosteronism. Hypertension. 2007;50:911–8.
Sukor N, Kogovsek C, Gordon RD, Robson D, Stowasser M. Improved quality of life, blood pressure, and biochemical status following laparoscopic adrenalectomy for unilateral primary aldosteronism. J Clin Endocrinol Metab. 2010;95:1360–4.
Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg. 2005;71:864–9.
Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med. 2001;135:258–61.
Brunt LM. The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc. 2002;16:252–7.
Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, et al. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension. 2008;51:1366–71.
Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, et al. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab. 2001;86:1066–71.
Rossi GP, Sacchetto A, Chiesura-Corona M, De Toni R, Gallina M, Feltrin GP, et al. Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab. 2001;86:1083–90.
Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136:1227–35.
Nwariaku FE, Miller BS, Auchus RJ, Holt S, Watumull L, Dolmatch B, et al. Primary hyperaldosteronism: advantages of adrenal vein sampling for subtype differentiation. Arch Surg. 2006;141:497–503.
Rossi GP, Ganzaroli C, Miotto D, De Toni R, Palumbo G, Feltrin GP, et al. Dynamic testing with high-dose adrenocorticotrophic hormone does not improve lateralization of aldosterone oversecretion in primary aldosteronism patients. J Hypertens. 2006;24:371–9.
Auchus RJ, Wians Jr FH, Anderson ME, Dolmatch BL, Trimmer CK, Josephs SC, et al. What we still do not know about adrenal vein sampling for primary aldosteronism. Horm Metab Res. 2010;42:411–5.
Auchus RJ, Michaelis C, Wians Jr FH, Dolmatch BL, Josephs SC, Trimmer CK, et al. Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg. 2009;249:318–21.
Auchus RJ, Chandler DW, Singeetham S, Chokshi N, Nwariaku FE, Dolmatch BL, et al. Measurement of 18-hydroxycorticosterone during adrenal vein sampling in primary aldosteronism. J Clin Endocrinol Metab. 2007;92:2648–51.
Doppman JL, Gill Jr JR. Hyperaldosteronism: sampling the adrenal veins. Radiology. 1996;198:309–12.
Young WF, Stanson AW. What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf). 2009;70:14–7.
Stewart PM, Allolio B. Adrenal vein sampling for primary aldosteronism: time for a reality check. Clin Endocrinol (Oxf). 2010;72:146–8.