Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Charitéplatz 1, D 10117 Berlin, Germany.
Best Pract Res Clin Endocrinol Metab. 2010 Dec;24(6):923-32. doi: 10.1016/j.beem.2010.10.001.
The prevalence of primary hyperaldosteronism approaches 10% of all hypertensive patients, and besides efficient diagnostic procedures, effective treatment is of increasing importance to reverse increased morbidity and mortality. Aldosterone-producing adenoma and unilateral adrenal hyperplasia are amenable to cure by endoscopic adrenalectomy. Bilateral adrenal hyperplasia (micro- or macronodular), which comprises two-thirds of primary hyperaldosteronism, is treated primarily by mineralocorticoid receptor antagonists (starting dose 12.5-25mg/day spironolactone with titration up to 100mg/day, alternatively 50-100mg/day eplerenone). If blood pressure is not normalised by this first-line treatment, additional treatment with potassium-sparing diuretics (amiloride or triamterene) or calcium channel antagonists is necessary. The start of medication should be closely monitored by serum electrolyte and creatinine controls.
原发性醛固酮增多症的患病率接近所有高血压患者的 10%，除了有效的诊断程序外，有效的治疗对于逆转发病率和死亡率的增加也越来越重要。醛固酮瘤和单侧肾上腺增生通过内镜肾上腺切除术可治愈。双侧肾上腺增生（微结节或大结节）占原发性醛固酮增多症的三分之二，主要通过盐皮质激素受体拮抗剂（起始剂量为每天 12.5-25mg 螺内酯，滴定至每天 100mg，或每天 50-100mg 依普利酮）治疗。如果一线治疗不能使血压正常化，则需要加用保钾利尿剂（阿米洛利或氨苯喋啶）或钙通道拮抗剂。药物治疗的开始应密切监测血清电解质和肌酐水平。
