Vetri Mario, Cassaniti Leonarda, Francese Giuseppina Maura, Gulizia Michele Massimo
U.O.C. Endocrinologia, Dipartimento di Biomedicina Clinica e Molecolare.
U.O.C. Cardiologia, Ospedale "Garibaldi Nesima", Catania.
G Ital Cardiol (Rome). 2021 Apr;22(4):319-326. doi: 10.1714/3574.35578.
Primary aldosteronism (PA) is the single most common cause of secondary hypertension and is associated with increased target organ injury. It can be can either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading to aldosterone-specific cardiovascular morbidity and nephrotoxicity. Thus, clinicians should perform case detection testing for PA at least once in all patients with hypertension. The diagnostic work-up of PA is a sequence of three phases comprising screening tests, confirmatory tests and the differentiation of unilateral from bilateral forms. With appropriate surgical expertise, laparoscopic unilateral adrenalectomy is safe, efficient and curative in patients with unilateral adrenal disease. In patients who have bilateral aldosterone hypersecretion, the optimal management is a low sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to maintain a high-normal serum potassium concentration without the aid of oral potassium supplements. In patients with PA, specific treatment provides prognostic benefit over optimal antihypertensive therapy and is therefore crucial to reduce mortality and morbidity in this subgroup of patients with hypertension.
原发性醛固酮增多症（PA）是继发性高血压最常见的单一病因，且与靶器官损伤增加有关。它既可以通过手术治愈，也可以采用靶向药物治疗。PA常常未被诊断和治疗，从而导致醛固酮特异性心血管疾病和肾毒性。因此，临床医生应至少对所有高血压患者进行一次PA病例检测。PA的诊断检查包括三个阶段，即筛查试验、确诊试验以及区分单侧与双侧形式。具备适当的手术专业知识后，腹腔镜单侧肾上腺切除术对于单侧肾上腺疾病患者而言是安全、有效且可治愈的。对于双侧醛固酮分泌过多的患者，最佳治疗方法是低钠饮食以及终身使用盐皮质激素受体拮抗剂进行治疗，给药剂量应维持血清钾浓度略高于正常水平，无需口服补钾。对于PA患者，特异性治疗相较于最佳降压治疗具有预后优势，因此对于降低该高血压亚组患者的死亡率和发病率至关重要。
