Rastreamento, Comprovação e Diferenciação Laboratorial do Hiperaldosteronismo Primário
Primary aldosteronism (PA), previously considered a rare cause of hypertension, may be responsible in recent series for 5-10% of the hypertensive population. Although one might consider PA as the main cause of secondary hypertension, caution is recommended when interpreting this sudden epidemics. Be...
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2002 |
| País: | Brasil |
| Institución: | Universidade Federal de São Paulo (UNIFESP) |
| Repositorio: | Repositório Institucional da UNIFESP |
| Idioma: | portugués |
| OAI Identifier: | oai:repositorio.unifesp.br:11600/1346 |
| Acceso en línea: | http://dx.doi.org/10.1590/S0004-27302002000100015 http://repositorio.unifesp.br/handle/11600/1346 |
| Access Level: | acceso abierto |
| Palabra clave: | Hypertension Mineralocorticoid excess Hyperaldosteronism Aldosterone Plasma renin activity Potassium Hipertensão Excesso mineralocorticóide Hiperaldosteronismo Aldosterona Atividade plasmática de renina Potássio |
| Sumario: | Primary aldosteronism (PA), previously considered a rare cause of hypertension, may be responsible in recent series for 5-10% of the hypertensive population. Although one might consider PA as the main cause of secondary hypertension, caution is recommended when interpreting this sudden epidemics. Because the classical manifestations of aldosterone excess are not always present, screening for PA must include determinations of random plasma aldosterone: renin ratios (ng/dl:ng/ml/h). Hypertensive patients with ratio> or =25 (and aldosterone >14ng/dl) must be further investigated with plasma/urine aldosterone suppression tests (IV saline infusion, oral fludrocortisone or high-sodium diets). Failure to suppress is typical of aldosterone autonomy in PA. Differentiation of the two main subgroups (aldosterone-producing adenoma - APA -, and bilateral adrenal hyperplasia or idiopathic hyperaldosteronism - IHA) is mandatory since therapeutic intervention varies. Distinction between APA and IHA is based on the absence of plasma aldosterone increases to renin stimulation (upright posture, diuretics or low-sodium diets) in the first, as opposed to exaggerated responses in the latter. The diagnostic workup must include an adrenal CT and, if necessary, bilateral adrenal vein catheterization and aldosterone measurement to ascertain the source of aldosterone excess. |
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