ПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ

Abstract

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.