Center for Adrenal Disorders, Division of Endocrinology, Diabetes, & Hypertension, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia.
J Clin Endocrinol Metab. 2020 Dec 1;105(12):3771-83. doi: 10.1210/clinem/dgaa606.
New approaches are needed to address the evolution of the primary aldosteronism syndrome and to increase its recognition. Herein, we review evidence indicating that primary aldosteronism is a prevalent syndrome that is mostly unrecognized, and present a pragmatic and pathophysiology-based approach to improve diagnosis and treatment.
Evidence was gathered from published guidelines and studies identified from PubMed by searching for primary aldosteronism, aldosterone, renin, and hypertension. This evidence was supplemented by the authors' personal knowledge, research experience, and clinical encounters in primary aldosteronism.
Renin-independent aldosterone production is a prevalent phenotype that is diagnosed as primary aldosteronism when severe in magnitude, but is largely unrecognized when milder in severity. Renin-independent aldosterone production can be detected in normotensive and hypertensive individuals, and the magnitude of this biochemical phenotype parallels the magnitude of blood pressure elevation, the risk for incident hypertension and cardiovascular disease, and the likelihood and magnitude of blood pressure reduction with mineralocorticoid receptor antagonist therapy. Expansion of the indications to screen for primary aldosteronism, combined with the use of a pathophysiology-based approach that emphasizes inappropriate aldosterone production in the context of renin suppression, will substantially increase the diagnostic and therapeutic yields for primary aldosteronism.
The landscape of primary aldosteronism has evolved to recognize that it is a prevalent syndrome of renin-independent aldosterone production that contributes to the pathogenesis of hypertension and cardiovascular disease. Expanding screening indications and simplifying the diagnostic approach will enable implementation of targeted treatment for primary aldosteronism.
需要新的方法来解决原发性醛固酮增多症的演变，并提高其识别率。在此，我们回顾了表明原发性醛固酮增多症是一种普遍存在但大多未被识别的综合征的证据，并提出了一种实用的基于病理生理学的方法来改善诊断和治疗。
从已发表的指南和通过在 PubMed 上搜索原发性醛固酮增多症、醛固酮、肾素和高血压而确定的研究中收集证据。作者的个人知识、研究经验和原发性醛固酮增多症的临床经验补充了这些证据。
独立于肾素的醛固酮产生是一种普遍存在的表型，当程度严重时被诊断为原发性醛固酮增多症，但当程度较轻时则大多未被识别。独立于肾素的醛固酮产生可在血压正常和高血压个体中检测到，这种生化表型的程度与血压升高的程度、发生高血压和心血管疾病的风险以及使用盐皮质激素受体拮抗剂治疗时血压降低的可能性和程度平行。扩大筛查原发性醛固酮增多症的指征，并结合使用基于病理生理学的方法，强调在肾素抑制的情况下不适当的醛固酮产生，将大大提高原发性醛固酮增多症的诊断和治疗效果。
原发性醛固酮增多症的研究现状已经发展到认识到它是一种普遍存在的、独立于肾素的醛固酮产生的综合征，它导致了高血压和心血管疾病的发病机制。扩大筛查指征并简化诊断方法将使原发性醛固酮增多症的靶向治疗得以实施。
