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Vol 12, No 2 (2008)
Editorial
Published online: 2008-04-03
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Primary aldosteronism - why is the diagnosis difficult?
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Nadciśnienie tętnicze 2008;12(2):75-79.
open access
Vol 12, No 2 (2008)
Artykuły redakcyjne
Published online: 2008-04-03
Abstract
Primary hyperaldosteronism (PA) is a pathogenically heterogenous
syndrome. It may be caused by: a) solitary or
multiple adenomata or carcinoma of the adrenal glomerular
zone, b) by unilateral or bilateral micro- or
macromodular hyperplasia of this zone, c) by a genetic
defect of steroidogenesis (famillial hyperaldosteronism type
I and II) oraz d) by extraadrenal aldosterone synthesis
(paraendocrinopathy). The classical signs and symptoms
of PA (aterial hypertension, hypokaliemia caused by
incressive renal K excretion, hypokalemic alkalosis, clinical
symptoms of K depletion) are found only in 20–40% of
patients with PA predominantly in those with solitary adenoma
of the adrenal glomerular zone. In these patients
almost always autonomous hypersecretion of aldosterone
may be found, while in the other pathological forms of PA
this is not always the case. Routine estimation of plasma
renin activity or renin concentration respectively and of
the aldosterone-renin ratio (ARR) significantly increased
the frequency of PA diagnosis in normokalemic hypertensive
patients. In patients with monogenic forms of low-renin hypertension and of so-called low-renin essential hypertension
performance of genetic examinations are often
necessary. The question, is there an epidemic of primary
aldosteronism which needs elaboration of new diagnostic
and therapeutic strategies in hypertensive patients - is
subject of continual controversy.
Abstract
Primary hyperaldosteronism (PA) is a pathogenically heterogenous
syndrome. It may be caused by: a) solitary or
multiple adenomata or carcinoma of the adrenal glomerular
zone, b) by unilateral or bilateral micro- or
macromodular hyperplasia of this zone, c) by a genetic
defect of steroidogenesis (famillial hyperaldosteronism type
I and II) oraz d) by extraadrenal aldosterone synthesis
(paraendocrinopathy). The classical signs and symptoms
of PA (aterial hypertension, hypokaliemia caused by
incressive renal K excretion, hypokalemic alkalosis, clinical
symptoms of K depletion) are found only in 20–40% of
patients with PA predominantly in those with solitary adenoma
of the adrenal glomerular zone. In these patients
almost always autonomous hypersecretion of aldosterone
may be found, while in the other pathological forms of PA
this is not always the case. Routine estimation of plasma
renin activity or renin concentration respectively and of
the aldosterone-renin ratio (ARR) significantly increased
the frequency of PA diagnosis in normokalemic hypertensive
patients. In patients with monogenic forms of low-renin hypertension and of so-called low-renin essential hypertension
performance of genetic examinations are often
necessary. The question, is there an epidemic of primary
aldosteronism which needs elaboration of new diagnostic
and therapeutic strategies in hypertensive patients - is
subject of continual controversy.
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Keywords
primary aldosteronism
About this articleTitle
Primary aldosteronism - why is the diagnosis difficult?
Journal
Issue
Article type
Editorial
Pages
75-79
Published online
2008-04-03
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Bibliographic record
Nadciśnienie tętnicze 2008;12(2):75-79.
Keywords
primary aldosteronism
Authors
Franciszek Kokot
Lidia Hyla-Klekot