2015, Número 3
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Rev Mex Cardiol 2015; 26 (3)
Diagnóstico y tratamiento de aldosteronismo primario
Sánchez TRA
Idioma: Ingles.
Referencias bibliográficas: 30
Paginas: 113-117
Archivo PDF: 178.37 Kb.
RESUMEN
El hiperaldosteronismo primario es un conjunto de patologías que comparten la biosíntesis excesiva e hipersecreción sostenida y autónoma de aldosterona. Clínicamente se manifiesta principalmente por: hipertensión arterial sistémica, hipokalemia y alcalosis metabólica. La conducta biológica de la hipertensión generalmente es severa y refractaria a los antihipertensivos habituales. Es la causa más frecuente de hipertensión arterial sistémica secundaria. Sus características bioquímicas son: PAC › 20 ng/dL, PRA ‹ 0.5 ng/mL/h, concentración de renina plasmática indetectable y/o baja e hipokalemia en el 50% de los casos. El diagnóstico se establece cuando el cociente PAC/PRA ≥ 50. Los estudios de localización son: tomografía computarizada, resonancia magnética y la concentración de aldosterona en las venas adrenales derecha e izquierda con gradiente ≥ 4 habiendo confirmado la correcta cateterización con la concentración de cortisol en venas adrenales y en vena cava inferior con proporción mínima de 5:1. Su tratamiento es quirúrgico, preferentemente a través de laparoscopía, aunque otros consideran que, según las dimensiones del tumor, puede ser mediante laparotomía para una minoría de casos. El tratamiento farmacológico es con antagonistas de los receptores de mineralocorticoides.
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