Hiperaldosteronismo primario y secundario

Abstract

Primary aldosteronism is the most common cause of secondary hypertension with and stimated prevalence ranging from 5 to 10% of all hypertensive patients. This entity presents with hypertension, in a minority of cases hypokalemia, and an increased risk of cardiovascular damage due to aldosterone excess. The diagnosis is made following a three-step approach: case-detection accomplished by measuring an ambulatory random plasmatic aldosterone concentration- renin activity ratio on standard testing conditions, aldosterone confirmatory supression testing, and then, an initial subtype classification by means of an adrenal imaging test (CT) to exclude potential malignant lesions. Unilateral laparoscopic adrenalectomy and mineralocorticoid receptor antagonist drugs are the choice treatment for patients with unilateral and bilateral disease, respectively. Other entities presenting with mineralocorticoid excess action but low aldosterone plasmatic concentration are apparent mineralocorticoid excess syndrome, primary cortisol resistance, Liddle's syndrome, deoxycorticosterone-producing tumors, certain types of congenital adrenal hyperplasia and hypertension exacerbated by pregnancy.