Division of Internal Medicine, Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy.
Horm Metab Res. 2010 Jun;42(6):406-10. doi: 10.1055/s-0029-1246186. Epub 2010 Jan 29.
Primary aldosteronism is the most common form of secondary hypertension and patients with hyperaldosteronism are more prone to premature cardiovascular complications compared to essential hypertensives. The diagnostic flow-chart for the diagnosis of PA is performed in three steps: a) screening; b) confirmation; and c) subtype differentiation. Instead of proceeding directly to subtype classification, the recently published Endocrine Society Guidelines recommend that patients with a positive ARR should undergo a confirmatory test, in order to definitively confirm or exclude the diagnosis of PA. The Guidelines recognize four testing procedures: oral sodium loading, saline infusion, fludrocortisone suppression, and captopril challenge. Herein we discuss the diagnostic protocols for these confirmatory tests and highlight both the advantages and contraindications and we discuss studies in which these confirmatory tests have been compared.
原发性醛固酮增多症是继发性高血压最常见的形式，与原发性高血压患者相比，醛固酮增多症患者更容易发生心血管并发症。醛固酮增多症的诊断流程图分为三个步骤：a）筛查；b）确诊；和 c）亚型鉴别。最近发表的《内分泌学会指南》建议，ARR 阳性的患者应进行确诊试验，以明确诊断或排除醛固酮增多症，而不是直接进行亚型分类。该指南认可了四种检测程序：口服钠负荷、盐水输注、氟氢可的松抑制和卡托普利挑战。本文讨论了这些确诊试验的诊断方案，重点介绍了它们的优势和禁忌证，并讨论了比较这些确诊试验的研究。
