Primary aldosteronism: Literature review
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
27
Journal Issue
3
Pages
123–134
Date Issued
2016-06-01
Author(s)
Abstract
The common characteristics of primary aldosteronism (PA) are hypertension and spontaneous hypokalemia due to dysregulation of superabundant aldosterone from the adrenal cortex. PA is one of the most common causes of endocrine hypertension and affects about 10% of the general hypertensive population. Unilateral aldosteroneproducing adenoma (APA) and bilateral adrenal hyperplasia (BAH) are two major subtypes. The former has a hypertension cure rate about 20 to 72% after surgical intervention while the latter should be treated as mineralocorticoid antagonist. The KCNJ5 gene somatic mutation resulting in potassium channelopathy has known to play a major role of APA. KCA/J5-mutatnt carriers attribues for 60 to 70% of the APA patients in Asia. We could use plasma aldosterone to renin ratio (ARR) as an initial screening test and then do confirmatory tests. After confirmation of PA, adrenal computed tomography (CT) should be performed in all. Before surgery, lateralization with invasive adrenal venous sampling (AVS) or noninvasive adrenal scintigraphy (NP-59 SPECT/CT) was necessary to identify the origin of excess aldosterone. Evidence shows long-term exposure to excess aldosterone results in organ damage or dysfunction including cardiac, blood vessel, pancreas, kidney, parathyroid, bone, psychiatric disorder etc. In view of this, it could be better for the general hypertensive population if the clinician could have more awareness on diagnosis and management of PA.
Type
journal article