Biomarkers to Guide Medical Therapy in Primary Aldosteronism

原发性醛固酮增多症 医学 低钾血症 肾上腺切除术 血压 不利影响 醛固酮 内科学 内分泌系统 泌尿科 醛固酮增多症 重症监护医学 内分泌学 生物信息学 激素 生物
作者
Gregory L. Hundemer,Alexander A. C. Leung,Gregory Kline,Jenifer M. Brown,Adina F. Turcu,Anand Vaidya
出处
期刊:Endocrine Reviews [The Endocrine Society]
卷期号:45 (1): 69-94 被引量:9
标识
DOI:10.1210/endrev/bnad024
摘要

Abstract Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin—biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.
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