Europe diagnosis and treatment of primary aldosteronism Guide Published
By the European Society of Endocrinology, Europe Hypertension Society, International Society for Endocrinology, the International Society of Hypertension and the Japanese Society of Hypertension 5 Institute of organizations in the development of "primary aldosteronism patients of case detection, diagnosis and treatment: Endocrine Society Clinical Practice Guidelines" (the "Guide") recently published in "Clinical Endocrinology and Metabolism" (JClinEndocrinMetab.JCEM) on, while in the U.S. Endocrine Society 90th Annual Meeting (ENDO08) published. The guide is intended to regulate development of primary aldosteronism (aldosterone) patients in the diagnosis and treatment, to increase awareness of the disease and the promotion of their clinical practice.
Is a group of aldosterone increased aldosterone secretion and renin – angiotensin system by inhibiting sodium load regulation, but not the disease. Increased aldosterone secretion can lead to cardiovascular damage, the inhibition of plasma renin, hypertension, sodium retention, hypokalemia and so on. Aldosterone is a common cause of adrenal adenoma, unilateral or bilateral adrenal hyperplasia, a rare genetic defect causes a result of glucocorticoid Hormone Adjustable aldosteronism (GRA).
Previously reported aldosterone in patients with mild to moderate hypertension prevalence rate of less than 1%, and the low serum potassium as a diagnostic conditions; but the original report of aldosterone in the prevalence of hypertension in greater than 10%; recent studies also showed that only 9% ~ 37% of patients with hypokalemia, therefore, hypokalemia may exist only in more serious cases; only 50% of the adenomas and 17% of the proliferation patients with serum potassium <3.5 mmol / l; hypokalemia aldosterone as a diagnostic sensitivity, specificity, and positive rate of diagnosis.
"Guide" recommended a relatively high degree of suspicion should be in aldosterone tested patients, including high blood pressure treatment guidelines according to the U.S. diagnosis of a hypertensive (blood pressure> 160 ~ 179/100 ~ 109 mm Hg) , 2 (blood pressure> 180/110 mm Hg), drug resistant hypertension, hypertension with persistent or diuretic induced hypokalemia, hypertension associated with adrenal incidentaloma, with early-onset hypertension or 40 years ago a family history of cerebral vascular accident patients with hypertension; also recommended in the first degree relatives of patients with primary aldosteronism in all hypertensive patients for screening.
In the diagnosis, the "Guide" recommended the use of plasma aldosterone and renin ratio (ARR) to screen patients in the primary aldosteronism patients. Select one of the following four kinds of tests and diagnosed or excluded based on the results as a basis for aldosterone that oral sodium loading test, saline infusion test, hydrogen fluoride cortisone suppression test or captopril test. Before the test should be out on the determination of influence of drugs.
"Guide" is also recommended for all patients diagnosed as primary aldosteronism patients with adrenal CT scan should be done to identify the subtype classification and location, and except for the larger masses of adrenal cortical carcinoma. That aldosterone MRI in the diagnosis of subtypes is not better than CT, CT expensive system than resolution of differences. If you choose surgery after diagnosis, and patients want surgery, additional identification is unilateral or bilateral adrenal lesions, namely, identification is adenoma or hyperplasia should be performed by experienced radiologists, selective adrenal venous blood samples (AVS) determination of aldosterone. More expensive because of AVS, and for the invasive procedures, it should be emphasized that the indications and to avoid adrenal bleeding complications.
"Guide" requirements, such as patients diagnosed with primary aldosteronism patients under 20 years of age, with the original aldehyde disease or family history of stroke in young people, should do genetic testing to diagnosis or exclude GRA.
In the treatment, the "Guide" recommended as confirmed unilateral aldosterone secreting tumor or unilateral adrenal hyperplasia, unilateral adrenalectomy should be laparoscopic resection; such as patients with inoperable, then the recommended salt receptor antagonist treatment. The case of bilateral adrenal hyperplasia, the recommended salt receptor antagonist treatment, suggested spironolactone (spironolactone) as first-line drug treatment, eplerenone as an alternative medication. GRA patients on the recommended low-dose corticosteroids, such as adult starting dose of dexamethasone 0.125 mg / day to 0.25 mg / day, prednisone adult starting dose of 2.5 mg / day to 5 mg / day, to correct hypertension and hypokalemia. Other drugs such as calcium channel blockers (CCB), ACE inhibition Preparation (ACEI), angiotensin receptor blocker (ARB) only a small number of primary aldosteronism in patients using the report, are thought to have anti-hypertensive effect, but did not antagonize the effect of high aldosterone; aldosterone synthase suppression Preparation May be used in the future.
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