Division of Nephrology, Hypertension, Dialysis and Transplantation, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia.
School of Medicine University of Zagreb, Zagreb, Croatia.
Kidney Blood Press Res. 2024;49(1):839-842. doi: 10.1159/000541441. Epub 2024 Sep 18.
Primary aldosteronism (PA), a common secondary cause of arterial hypertension, is treated either surgically or pharmacologically with mineralocorticoid receptor antagonists (MRAs). These drugs, while effective, can cause allergic reactions and have side effects, including menstrual cycle disorders in women. Finerenone is a new, highly selective, nonsteroidal MRA with excellent side-effect profile, primarily intended to slow the progression of diabetic kidney disease and improve cardiovascular outcomes in these patients. No data are available so far on its effect on patients with PA.
A case of a female patient with confirmed primary aldosteronism, in whom adrenal vein sampling failed twice is presented. The patient developed a skin allergic reaction to spironolactone and experienced prolonged vaginal bleedings with eplerenone, which was attributed to the drug's affinity for progesterone receptors. A trial of finerenone was initiated, resulting in mild increase in plasma renin activity and serum potassium, and somewhat control of blood pressure, but far from optimal blood pressure control, normokalemia, or unsuppression of plasma renin activity.
This case highlights the challenges of managing PA and describes an attempt of treatment with finerenone to which this patient unfortunately did not adequately respond.
原发性醛固酮增多症（PA）是一种常见的继发性高血压病因，可通过手术或使用盐皮质激素受体拮抗剂（MRA）进行药物治疗。这些药物虽然有效，但可能会引起过敏反应和副作用，包括女性的月经周期紊乱。非奈利酮是一种新型、高度选择性、非甾体类 MRA，具有出色的副作用谱，主要用于减缓糖尿病肾病患者的疾病进展并改善这些患者的心血管结局。目前尚无关于其对 PA 患者影响的数据。
本文介绍了一例经证实患有原发性醛固酮增多症的女性患者，该患者两次肾上腺静脉取样均失败。该患者对螺内酯发生皮肤过敏反应，并因依普利酮对孕激素受体的亲和力而出现持续阴道出血。尝试使用非奈利酮治疗，但导致血浆肾素活性和血清钾轻度升高，血压有所控制，但远未达到最佳血压控制、血钾正常或血浆肾素活性不受抑制的目标。
本病例强调了管理 PA 的挑战，并描述了使用非奈利酮治疗的尝试，但该患者对此治疗反应不佳。
