Update in diagnosis and management of primary aldosteronism

Dick, Sofia Michele; Queiroz, Marina; Bernardi, Bárbara Luisa; Dall’Agnol, Angélica; Brondani, Letícia A.; Silveiro, Sandra Pinho

doi:10.1515/cclm-2017-0217

Cited by 28 publications

(23 citation statements)

References 74 publications

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“…kidneys, heart) are characteristics of PHA. The prevalence of the disease ranges from 5% to 12% in literature [3]. The most common causes of PHA are adrenal adenoma and hyperplasia [3].…”

Section: Discussionmentioning

confidence: 99%

Untitled

Kurtkulağı

Aktas

Kocak

et al. 2020

PEP

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Primary hyperaldosteronism (PHA) is a syndrome characterized by increased aldosterone release andsuppressed renin-angiotensin cascade. Hypertension, alteration in potassium homeostasis, and target tissuedamage are characteristic features of the disease. The importance of recognizing PHA is due to the fact that ithas a very negative cardiovascular and renal effect which can result in death. In this case report, we presenta patient with resistant hypokalemia whom consequently diagnosed with PHA. A 54-year-old female patientwho was scheduled for operation due to congenital hip dislocation was found to have decreased serum potassiumin her preoperative laboratory tests. Therefore, the patient was referred to the internal medicine outpatientclinic with a serum potassium value of 2.1 mmol/L. Her systolic and diastolic blood pressures were 150 and90 mmHg, respectively. On electrocardiogram, prominent U waves were noted. Therefore, potassium replacementwas initiated at once by intravenous route. The potassium value in spot urine was 12.4 mmol/L. A 24 hoururine collected and urinary potassium excretion in 24 hours of urine was detected as 15 mmol/L, which meanstranstubular potassium gradient was greater than 4 mmol/L. Since she was hypertensive during clinical followup in the ward, hypertension along with hypokalemia raised the clinical suspicion of hyperaldosteronism.Serum aldosterone renin ratio was measured as 155 %. A computerized tomography scan revealed (22 × 16 mm)neoplasm which was suggestive of adrenal adenoma in the right adrenal gland. Cushing Syndrome was ruledout with a normal cortisol level and pheochromocytoma was ruled out by normal levels of metanephrine in the24 hours of urine. Spironolactone 50 mg was initiated and serum potassium was raised to normal range. Shescheduled for unilateral adrenalectomy and discharged with full recovery of hypokalemia. Since PHA has undesiredcardiovascular and renal effects which may increase mortality and morbidity, establishing the diagnosisas soon as possible is crucial. Hypertensive patients with hypokalemia or adrenal incidentaloma or obstructivesleep apnea syndrome, resistant hypertensive subjects, patients with moderate or severe hypertension, and hypertensive patients with a family history of PHA should undergo screening for PHA. In conclusion, we suggestthat PHA should be kept in mind in differential diagnosis of the patients with hypertension and hypokalemia.

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“…kidneys, heart) are characteristics of PHA. The prevalence of the disease ranges from 5% to 12% in literature [3]. The most common causes of PHA are adrenal adenoma and hyperplasia [3].…”

Section: Discussionmentioning

confidence: 99%

Untitled

Kurtkulağı

Aktas

Kocak

et al. 2020

PEP

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“…Untuk pasien dengan penyakit adrenal bilateral (IHA dan GRA) antagonis aldosteron adalah pilihan lini pertama (Gambar 2). 20,27 Pada pasien ini terkonfirmasi dengan tumor adrenal kiri, sehingga terapi pilihan utama pada pasien ini adalah tindakan adrenalektomi.…”

Section: Familial Hyperaldosteronismunclassified

“…Selain itu, modalitas terapi lain yang dapat digunakan adalah eplerenon dan amiloride. 27 Adrenalektomi unilateral merupakan pilihan terapi pada hipersekresi aldosteron unilateral (APA atau UAH). Adrenalektomi merupakan pendekatan operasi yang saat ini banyak digunakan.…”

Section: Familial Hyperaldosteronismunclassified

Conn’s Syndrome Akibat Adenoma Adrenal

Rasyid¹,

Bakri²,

Kasim³

et al. 2019

JPDI

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Conn’s syndrome merupakan sindrom yang ditandai dengan peningkatan kadar aldosteron yang menyebabkan retensi natrium dan peningkatan ekskresi kalium melalui urin. Sindrom ini ditandai dengan trias hipokalemia, hipertensi, dan alkalosis metabolik. Artikel ini membahas mengenai laporan kasus pasien hipertensi tidak terkontrol dengan gejala neuromuskular yang diakibatkan oleh hipokalemia berulang. Setelah dilakukan evaluasi tes pencitraan, ditemukan gambaran tumor adrenal kiri dan kemudian dilakukan tindakan adrenalektomi unilateral. Hasil pemeriksaan histopatologi tumor didapatkan gambaran yang sesuai dengan adenoma adrenal. Setelah tindakan adrenalektomi unilateral, pasien menunjukkan perbaikan klinis dan laboratorium. Kata kunci : Conn’s syndrome, Hipertensi, HipokalemiaConn’s Syndrome Due to Adrenal AdenomaConn's syndrome is characterized by an increase in aldosterone level causes sodium retention and an increase in urine excretion of potassium. This syndrome is characterized by trias hypokalemia, hypertension, and metabolic alkalosis. This article discussed a case report of a patient with uncontrolled hypertension with neuromuscular symptoms caused by recurrent hypokalemia. After an evaluation of the imaging test, we found a left adrenal tumor then we performed unilateral adrenalectomy surgery. Histopathology examination from the excised tumor revealed the adrenal adenoma. After unilateral adrenalectomy, the patient showed clinical and laboratory improvement.

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“…Однако S. Dick и соавт. в своем обзоре отмечают, что данные рекомендации имеют низкую доказательную силу, так как опираются на результаты небольших ретроспективных наблюдательных исследований [23,24]. Как бы то ни было, доля пациентов, соответствующих этим критериям, среди всех больных ПГА составляет не более 10% [25].…”

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Primary hyperaldosteronism: difficulties in diagnosis

Shifman

Михайлович²,

Платонова

et al. 2019

Terapevticheskii arkhiv

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Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.

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Update in diagnosis and management of primary aldosteronism

Cited by 28 publications

References 74 publications

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Conn’s Syndrome Akibat Adenoma Adrenal

Primary hyperaldosteronism: difficulties in diagnosis

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