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2015, Number 3

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Rev Mex Cardiol 2015; 26 (3)

Diagnosis and management of primary aldosteronism

Sánchez TRA

Language: English
References: 30
Page: 113-117
PDF size: 178.37 Kb.


ABSTRACT

Primary hyperaldosteronism is a set of pathologies that share an excessive biosynthesis, and sustained autonomous aldosterone hypersecretion. This condition is mainly manifested clinically by: systemic arterial hypertension, hypokalemia, and metabolic alkalosis. Biological hypertension behavior is generally severe and refractory to the usual antihypertensive medication and it is the most frequent cause of secondary systemic arterial hypertension. Their biochemical characteristics are: plasma aldosterone concentration (PAC) › 20 ng/dL, plasma renin activity (PRA) ‹ 0.5 ng/mL/h, undetectable and/or low plasmatic renin concentration, and hypokalemia in 50% of the cases. Diagnosis is established when PAC/PRA ratio is ≥ 50. Location tests include: computed tomography, magnetic resonance imaging, and aldosterone measurement in right and left adrenal veins with a gradient ≥ 4, confirming catheterization of adrenal veins with cortisol concentration ratio at least 5:1 in relation to inferior vena cava. It is preferred a surgical treatment with laparoscopy in most cases, though some physicians consider, depending on the tumor size, a pharmacological treatment with mineralocorticoid receptor antagonists.


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