Corry D B, Tuck M L
Department of Medicine, Olive View Medical Center, Sylmar California, USA.
Endocrinol Metab Clin North Am. 1995 Sep;24(3):511-29.
Conditions of secondary aldosteronism are common in clinical medicine, occurring in normotensive and hypertensive settings. In some conditions such as edema disorders, this represents a partially beneficial response to restore volume and Na at the expense of hypokalemia. In RVH and malignant hypertension, the aldosteronism may be beneficial, but most evidence shows a detrimental impact. In both situations, aldosterone does not compensate fully for Na degradation and facilitates K loss. In pregnancy, aldosterone's effects is more successful for volume conservation, and the action on K is almost completely overridden by other K-sparing factors. Chronic renal failure seems to best benefit from hyperaldosteronism, but the response is limited because aldosterone must act on extrarenal targets. In iatrogenic causes of secondary aldosteronism, the effects of aldosterone are mostly detrimental. The overall conclusion supports the hypothesis that aldosterone functions best in physiologic situations, but in pathophysiologic settings it does not perfectly compensate for the basic defect. This implies that in these complex conditions, successful therapy should address the disorder in aldosterone and also the other underlying pathophysiologic mechanisms.
继发性醛固酮增多症在临床医学中很常见，可发生于血压正常和高血压的情况下。在某些疾病如水肿性疾病中，这代表了一种以低钾血症为代价来恢复血容量和钠的部分有益反应。在右心室肥厚和恶性高血压中，醛固酮增多症可能有益，但大多数证据显示其有有害影响。在这两种情况下，醛固酮都不能完全补偿钠的降解，反而会促进钾的流失。在妊娠期间，醛固酮在维持血容量方面的作用更为成功，而其对钾的作用几乎完全被其他保钾因素所抵消。慢性肾衰竭似乎从醛固酮增多症中获益最大，但这种反应是有限的，因为醛固酮必须作用于肾外靶点。在继发性醛固酮增多症的医源性病因中，醛固酮的作用大多是有害的。总体结论支持这样一种假说，即醛固酮在生理情况下功能最佳，但在病理生理情况下，它并不能完美地补偿基本缺陷。这意味着在这些复杂的情况下，成功的治疗应针对醛固酮紊乱以及其他潜在的病理生理机制。
