Moo Tracy-Ann, Zarnegar Rasa, Duh Quan-Yang
Sergical Service, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
Curr Treat Options Oncol. 2007 Aug;8(4):314-21. doi: 10.1007/s11864-007-0039-8.
Primary aldosteronism is one of the most common causes of secondary hypertension. In recent years the prevalence has risen dramatically, from 1% to 14% of all hypertensive patients. This has been largely attributed to an increase in diagnosis. Primary aldosteronism is characterized by hypertension with or without hypokalemia and a high plasma aldosterone concentration (PAC) with a concurrent low plasma renin activity (PRA). The most common subtypes of primary aldosteronism are aldosterone-producing adenoma (42%) and bilateral idiopathic hyperaldosteronism (58%). Other less common subtypes (<1%) are glucocorticoid-remediable aldosteronism, and unilateral primary hyperplasia. Current treatment for primary aldosteronism relies on accurate subtype distinction and assessment of unilateral versus bilateral disease. Bilateral idiopathic hyperaldosteronism is best managed pharmacologically and improves with the use of aldosterone receptor antagonists. Combined treatment with sodium-channel blockers and calcium-channel blockers has also shown satisfactory results. Glucocorticoid-remediable aldosteronism responds well to treatment with low-dose glucocorticoids. Aldosterone producing adenoma and unilateral adrenal hyperplasia are appropriately treated with laparoscopic adrenalectomy. Following adrenalectomy blood pressure improves in 98% of these patients, but only about 33% require no further antihypertensive medication. Identifying the subgroups that will most benefit from adrenalectomy is paramount to formulating individual treatment strategies. In the past, treatment focused mainly on the correction of hypertension and electrolyte disturbances. Now, with accumulating evidence of the detrimental effects of aldosterone to the myocardium, vascular endothelium and kidneys, treatment also focuses on normalizing aldosterone levels or blocking aldosterone action at the receptor level. Therefore, it is essential to accurately identify the specific subtype of primary aldosteronism in order to select optimal treatment and to achieve successful patient outcomes.
原发性醛固酮增多症是继发性高血压最常见的病因之一。近年来，其患病率急剧上升，在所有高血压患者中的占比从1%升至14%。这主要归因于诊断率的提高。原发性醛固酮增多症的特征是伴有或不伴有低钾血症的高血压，以及血浆醛固酮浓度（PAC）升高同时血浆肾素活性（PRA）降低。原发性醛固酮增多症最常见的亚型是醛固酮瘤（42%）和双侧特发性醛固酮增多症（(58%）。其他较罕见的亚型（<1%）是糖皮质激素可治性醛固酮增多症和单侧原发性肾上腺增生。目前原发性醛固酮增多症的治疗依赖于准确区分亚型以及评估单侧与双侧疾病。双侧特发性醛固酮增多症最好采用药物治疗，使用醛固酮受体拮抗剂可改善病情。联合使用钠通道阻滞剂和钙通道阻滞剂也显示出令人满意的效果。糖皮质激素可治性醛固酮增多症对小剂量糖皮质激素治疗反应良好。醛固酮瘤和单侧肾上腺增生适合通过腹腔镜肾上腺切除术进行治疗。肾上腺切除术后，98%的患者血压会改善，但只有约33%的患者无需进一步服用抗高血压药物。确定最能从肾上腺切除术中获益的亚组对于制定个体化治疗策略至关重要。过去，治疗主要集中在纠正高血压和电解质紊乱。现在，随着越来越多的证据表明醛固酮对心肌、血管内皮和肾脏有有害影响，治疗也侧重于使醛固酮水平正常化或在受体水平阻断醛固酮作用。因此，准确识别原发性醛固酮增多症的具体亚型对于选择最佳治疗方法并实现患者的成功治疗结果至关重要。
