Araujo-Castro Marta
Unidad de Neuroendocrinología, Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España.
Med Clin (Barc). 2020 Oct 9;155(7):302-308. doi: 10.1016/j.medcli.2020.04.029. Epub 2020 Jun 23.
Primary aldosteronism is associated with higher cardiovascular and renal morbidity and mortality than essential hypertension in age- and sex-matched patients with the same degree of blood pressure elevation. Therefore, it is essential to establish a specific treatment to avoid the deleterious effects of aldosterone excess. Although adrenalectomy is generally considered the treatment of choice in cases of primary aldosteronism due to unilateral disease, several aspects and circumstances should be taken into account that may make medical treatment more appropriate. Among them, in this review we mention the limited experience and efficacy, and the potential risks of adrenal vein sampling; the risks and low efficacy of adrenalectomy; the high safety and efficacy of medical treatment and some special situations such as primary aldosteronism during pregnancy, in patients of advanced age or hereditary forms of primary aldosteronism, in which medical treatment is considered especially indicated as the first line therapy. The main studies comparing medical and surgical treatment in primary aldosteronism are also discussed.
在年龄和性别匹配、血压升高程度相同的患者中，原发性醛固酮增多症比原发性高血压具有更高的心血管和肾脏发病率及死亡率。因此，必须建立一种特异性治疗方法以避免醛固酮过量带来的有害影响。尽管肾上腺切除术通常被认为是因单侧疾病导致的原发性醛固酮增多症病例的首选治疗方法，但仍应考虑几个可能使药物治疗更为合适的方面和情况。其中，在本综述中我们提到了肾上腺静脉采血的经验和疗效有限以及潜在风险；肾上腺切除术的风险和疗效较低；药物治疗的高安全性和疗效以及一些特殊情况，如妊娠期间的原发性醛固酮增多症、老年患者或原发性醛固酮增多症的遗传形式，在这些情况下药物治疗被认为是特别合适的一线治疗方法。本文还讨论了比较原发性醛固酮增多症药物治疗和手术治疗的主要研究。
