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Reviews in Endocrine and Metabolic Disorders

Erschienen in:

01.03.2011

Treatment of primary aldosteronism: Where are we now?

verfasst von: Asterios Karagiannis

Erschienen in: Reviews in Endocrine and Metabolic Disorders | Ausgabe 1/2011

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Abstract

Primary aldosteronism (PA) is an important cause of secondary hypertension, is being increasingly diagnosed and may account for more than 10% of hypertensive patients, both in primary care and in referral centers. Aldosterone excess is associated with adverse cardiovascular, renal and metabolic effects that are in part hypertension-independent. Laparoscopic adrenalectomy remains the mainstay of treatment for unilateral forms of PA, whereas medical treatment is recommended for bilateral forms of PA. However, a favourable surgical outcome depends on several factors and many patients are not suitable for this treatment. On the other hand, surgery in patients considered to have bilateral PA may contribute to better blood pressure control. In this review, established and novel strategies for the management of different types of PA are discussed.

Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3266–81.PubMedCrossRef

Anagnostis P, Karagiannis A, Tziomalos K, Athyros VG, Kita M, Mikhailidis DP. Endocrine hypertension: diagnosis and management of a complex clinical entity. Curr Vasc Pharmacol. 2010;8:646–60.PubMedCrossRef

Karagiannis A, Mikhailidis DP, Athyros VG, Harsoulis F. Pheochromocytoma: an update on genetics and management. Endocr Relat Cancer. 2007;14:935–56.PubMedCrossRef

Karagiannis A, Tziomalos K, Anagnostis P, Gossios T, Athyros VG. Atherosclerotic renal artery stenosis: medical therapy alone or in combination with revascularization? Angiology. 2009;60:397–402.PubMedCrossRef

Gordon RD, Ziesak MD, Tunny TJ, Stowasser M, Klemm SA. Evidence that primary aldosteronism may not be uncommon: 12% incidence among antihypertensive drug trial volunteers. Clin Exp Pharmacol Physiol. 1993;20:296–8.PubMedCrossRef

Lim PO, Young WF, MacDonald TM. A review of the medical treatment of primary aldosteronism. J Hypertens. 2001;19:353–61.PubMedCrossRef

Fardella CE, Mosso L, Gómez-Sánchez C, Cortés P, Soto J, Gómez L, et al. Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab. 2000;85:1863–7.PubMedCrossRef

Loh KC, Koay ES, Khaw MC, Emmanuel SC, Young Jr WF. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab. 2000;85:2854–9.PubMedCrossRef

Giacchetti G, Turchi F, Boscaro M, Ronconi V. Management of primary aldosteronism: its complications and their outcomes after treatment. Curr Vasc Pharmacol. 2009;7:244–49.PubMedCrossRef

10.

Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:e510–26.PubMedCrossRef

11.

Rocha R, Stier Jr CT. Pathophysiological effects of aldosterone in cardiovascular tissues. Trends Endocrinol Metab. 2001;12:308–14.PubMedCrossRef

12.

Tsioufis C, Tsiachris D, Dimitriadis K, Stougiannos P, Missovoulos P, Kakkavas A, et al. Myocardial and aortic stiffening in the early course of primary aldosteronism. Clin Cardiol. 2008;31:431–6.PubMedCrossRef

13.

Brilla CG, Weber KT. Reactive and reparative myocardial fibrosis in arterial hypertension in the rat. Cardiovasc Res. 1992;26:671–7.PubMedCrossRef

14.

Ramires FJ, Mansur A, Coelho O, Maranhão M, Gruppi CJ, Mady C, et al. Effect of spironolactone on ventricular arrhythmias in congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy. Am J Cardiol. 2000;85:1207–11.PubMedCrossRef

15.

Holaj R, Zelinka T, Wichterle D, Petrák O, Strauch B, Widimský Jr J. Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension. J Hypertens. 2007;25:1451–7.PubMedCrossRef

16.

Bernini G, Galetta F, Franzoni F, Bardini M, Taurino C, Bernardini M, et al. Arterial stiffness, intima-media thickness and carotid artery fibrosis in patients with primary aldosteronism. J Hypertens. 2008;26:2399–405.PubMedCrossRef

17.

Tsuchiya K, Yoshimoto T, Hirata Y. Endothelial dysfunction is related to aldosterone excess and raised blood pressure. Endocr J. 2009;56:553–9.PubMedCrossRef

18.

Staermose S, Marwick TH, Gordon RD, Cowley D, Dowling A, Stowasser M. Elevated serum interleukin 6 levels in normotensive individuals with familial hyperaldosteronism type 1. Hypertension. 2009;53:e31–2.PubMedCrossRef

19.

Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, et al. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension. 2006;48:232–8.PubMedCrossRef

20.

Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C. Intrarenal hemodynamics in primary aldosteronism before and after treatment. J Clin Endocrinol Metab. 2009;94:1191–7.PubMedCrossRef

21.

Fallo F, Veglio F, Bertello C, Sonino N, Della Mea P, Ermani M, et al. Prevalence and characteristics of the metabolic syndrome in primary aldosteronism. J Clin Endocrinol Metab. 2006;91:454–9.PubMedCrossRef

22.

Giacchetti G, Ronconi V, Turchi F, Agostinelli L, Mantero F, Rilli S, et al. Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study. J Hypertens. 2007;25:177–86.PubMedCrossRef

23.

Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45:1243–8.PubMedCrossRef

24.

Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med. 2008;168:80–5.PubMedCrossRef

25.

Born-Frontsberg E, Reincke M, Rump LC, Hahner S, Diederich S, Lorenz R, et al. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s Registry. J Clin Endocrinol Metab. 2009;94:1125–30.PubMedCrossRef

26.

Conn JW. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med. 1955;45:3–17.PubMed

27.

Davis WW, Newsome Jr HH, Wright Jr LD, Hammond WG, Easton J, Bartter FC. Bilateral adrenal hyperplasia as a cause of primary aldosteronism with hypertension, hypokalemia and suppressed renin activity. Am J Med. 1967;42:642–7.PubMedCrossRef

28.

Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66:607–18.CrossRef

29.

Lifton RP, Dluhy RG, Powers M, Rich GM, Cook S, Ulick S, et al. A chimaeric 11 beta-hydroxylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature. 1992;355:262–5.PubMedCrossRef

30.

Litchfield WR, Anderson BF, Weiss RJ, Lifton RP, Dluhy RG. Intracranial aneurysm and hemorrhagic stroke in glucocorticoid-remediable aldosteronism. Hypertension. 1998;31(1 Pt 2):445–50.PubMed

31.

So A, Duffy DL, Gordon RD, Jeske YW, Lin-Su K, New MI, et al. Familial hyperaldosteronism type II is linked to the chromosome 7p22 region but also shows predicted heterogeneity. J Hypertens. 2005;23:1477–84.PubMedCrossRef

32.

Geller DS, Zhang J, Wisgerhof MV, Shackleton C, Kashgarian M, Lifton RP. A novel form of human mendelian hypertension featuring nonglucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab. 2008;93:3117–23.PubMedCrossRef

33.

Rossi H, Kim A, Prinz RA. Primary hyperaldosteronism in the era of laparoscopic adrenalectomy. Am Surg. 2002;68:253–6.PubMed

34.

Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91:1259–74.PubMedCrossRef

35.

Sirén J, Välimäki M, Huikuri K, Sivula A, Voutilainen P, Haapiainen R. Adrenalectomy for primary aldosteronism: long-term follow-up study in 29 patients. World J Surg. 1998;22:418–21.PubMedCrossRef

36.

Shen WT, Lim RC, Siperstein AE, Clark OH, Schecter WP, Hunt TK, et al. Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg. 1999;134:628–31.PubMedCrossRef

37.

Favia G, Lumachi F, Scarpa V, D’Amico DF. Adrenalectomy in primary aldosteronism: a long-term follow-up study in 52 patients. World J Surg. 1992;16:680–3.PubMedCrossRef

38.

Obara T, Ito Y, Okamoto T, Kanaji Y, Yamashita T, Aiba M, et al. Risk factors associated with postoperative persistent hypertension in patients with primary aldosteronism. Surgery. 1992;112:987–93.PubMed

39.

Simon D, Goretzki PE, Lollert A, Röher HD. Persistent hypertension after successful adrenal operation. Surgery. 1993;114:1189–95.PubMed

40.

Blumenfeld JD, Sealey JE, Schlussel Y, Vaughan Jr ED, Sos TA, Atlas SA, et al. Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med. 1994;121:877–85.PubMed

41.

Weigel RJ, Wells SA, Gunnells JC, Leight GS. Surgical treatment of primary hyperaldosteronism. Ann Surg. 1994;219:347–52.PubMedCrossRef

42.

Celen O, O’Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism. Arch Surg. 1996;131:646–50.PubMed

43.

Lo CY, Tam PC, Kung AW, Lam KS, Wong J. Primary aldosteronism. Results of surgical treatment. Ann Surg. 1996;224:125–30.PubMedCrossRef

44.

Proye CA, Mulliez EA, Carnaille BM, Lecomte-Houcke M, Decoulx M, Wémeau JL, et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery. 1998;124:1128–33.PubMedCrossRef

45.

Sapienza P, Cavallaro A. Persistent hypertension after removal of adrenal tumours. Eur J Surg. 1999;165:187–92.PubMedCrossRef

46.

Brunt LM, Moley JF, Doherty GM, Lairmore TC, DeBenedetti MK, Quasebarth MA. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery. 2001;130:629–34.PubMedCrossRef

47.

Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med. 2001;135:258–61.PubMed

48.

Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, et al. Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy. Hypertens Res. 2002;25:11–8.PubMedCrossRef

49.

Harris DA, Au-Yong I, Basnyat PS, Sadler GP, Wheeler MH. Review of surgical management of aldosterone secreting tumours of the adrenal cortex. Eur J Surg Oncol. 2003;29:467–74.PubMedCrossRef

50.

Meria P, Kempf BF, Hermieu JF, Plouin PF, Duclos JM. Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases. J Urol. 2003;169:32–5.PubMedCrossRef

51.

Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, et al. High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens. 2003;21:2149–57.PubMedCrossRef

52.

Goh BK, Tan YH, Yip SK, Eng PH, Cheng CW. Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism. JSLS. 2004;8:320–5.PubMed

53.

Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism. World J Surg. 2005;29:155–9.PubMedCrossRef

54.

Gockel I, Heintz A, Polta M, Junginger T. Long-term results of endoscopic adrenalectomy for Conn’s syndrome. Am Surg. 2007;73:174–80.PubMed

55.

Pang TC, Bambach C, Monaghan JC, Sidhu SB, Bune A, Delbridge LW, et al. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg. 2007;77:768–73.PubMedCrossRef

56.

Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg. 2005;71:864–9.PubMed

57.

Karagiannis A, Tziomalos K, Dona K, Pyrpasopoulou A, Kartali N, Athyros V, et al. Bilateral renal artery stenosis and primary aldosteronism in a diabetic patient. QJM. 2005;98:913–5.PubMedCrossRef

58.

Jeunemaitre X, Chatellier G, Kreft-Jais C, Charru A, DeVries C, Plouin PF, et al. Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol. 1987;60:820–5.PubMedCrossRef

59.

Garthwaite SM, McMahon EG. The evolution of aldosterone antagonists. Mol Cell Endocrinol. 2004;217:27–31.PubMedCrossRef

60.

de Gasparo M, Joss U, Ramjoué HP, Whitebread SE, Haenni H, Schenkel L, et al. Three new epoxy-spirolactone derivatives: characterization in vivo and in vitro. J Pharmacol Exp Ther. 1987;240:650–6.PubMed

61.

Karagiannis A, Tziomalos K, Kakafika A, Florentin M, Athyros VG. Eplerenone relieves spironolactone-induced painful gynaecomastia in a patient with primary aldosteronism. Nephrol Dial Transplant. 2007;22:293.PubMedCrossRef

62.

Karagiannis A, Tziomalos K, Papageorgiou A, Kakafika AI, Pagourelias ED, Anagnostis P, et al. Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism. Expert Opin Pharmacother. 2008;9:509–15.PubMedCrossRef

63.

Griffing GT, Cole AG, Aurecchia SA, Sindler BH, Komanicky P, Melby JC. Amiloride in primary hyperaldosteronism. Clin Pharmacol Ther. 1982;31:56–61.PubMedCrossRef

64.

Mantero F, Opocher G, Rocco S, Carpenè G, Armanini D. Long-term treatment of mineralocorticoid excess syndromes. Steroids. 1995;60:81–6.PubMedCrossRef

65.

Veglio F, Pinna G, Bisbocci D, Rabbia F, Piras D, Chiandussi L. Efficacy of nicardipine slow release (SR) on hypertension, potassium balance and plasma aldosterone in idiopathic aldosteronism. J Hum Hypertens. 1990;4:579–82.PubMed

66.

Brown MJ, Hopper RV. Calcium-channel blockade can mask the diagnosis of Conn’s syndrome. Postgrad Med J. 1999;75:235–6.PubMed

67.

Mantero F, Fallo F, Opocher G, Armanini D, Boscaro M, Scaroni C. Effect of angiotensin II and converting enzyme inhibitor (captopril) on blood pressure, plasma renin activity and aldosterone in primary aldosteronism. Clin Sci (Lond). 1981;61 Suppl 7:289s–93s.

68.

Griffing GT, Melby JC. The therapeutic effect of a new angiotensin-converting enzyme inhibitor, enalapril maleate, in idiopathic hyperaldosteronism. J Clin Hypertns. 1985;1:265–76.

69.

Wisgerhof M, Carpenter PC, Brown RD. Increased adrenal sensitivity to angiotensin II in idiopathic hyperaldosteronism. J Clin Endocrinol Metab. 1978;47:938–43.PubMedCrossRef

70.

Stokes GS, Monaghan JC, Ryan M, Woodward M. Efficacy of an angiotensin II receptor antagonist in managing hyperaldosteronism. J Hypertens. 2001;19:1161–5.PubMedCrossRef

71.

Ménard J, Gonzalez MF, Guyene TT, Bissery A. Investigation of aldosterone-synthase inhibition in rats. J Hypertens. 2006;24:1147–55.PubMedCrossRef

72.

Takeda Y, Miyamori I, Inaba S, Furukawa K, Hatakeyama H, Yoneda T, et al. Vascular aldosterone in genetically hypertensive rats. Hypertension. 1997;29(1 Pt 1):45–8.PubMed

73.

Silvestre JS, Robert V, Heymes C, Aupetit-Faisant B, Mouas C, Moalic JM, et al. Myocardial production of aldosterone and corticosterone in the rat. Physiological regulation. J Biol Chem. 1998;273:4883–91.PubMedCrossRef

74.

Ahmad N, Romero DG, Gomez-Sanchez EP, Gomez-Sanchez CE. Do human vascular endothelial cells produce aldosterone? Endocrinolgy. 2004;145:3626–9.CrossRef

75.

Fiebeler A, Nussberger J, Shagdarsuren E, Rong S, Hilfenhaus G, Al-Saadi N, et al. Aldosterone synthase inhibitor ameliorates angiotensin II-induced organ damage. Circulation. 2005;111:3087–94.PubMedCrossRef

76.

Brand E, Chatelain N, Mulatero P, Féry I, Curnow K, Jeunemaitre X, et al. Structural analysis and evaluation of the aldosterone synthase gene in hypertension. Hypertension. 1998;32:198–204.PubMed

77.

Taymans SE, Pack S, Pak E, Torpy DJ, Zhuang Z, Stratakis CA. Human CYP11B2 (aldosterone synthase) maps to chromosome 8q24.3. J Clin Endocrinol Metab. 1998;83:1033–6.PubMedCrossRef

78.

Raizada MK, Francis SC, Wang H, Gelband CH, Reaves PY, Katovich MJ. Targeting of the renin-angiotensin system by antisense gene therapy: a possible strategy for the long-term control of hypertension. J Hypertens. 2000;18:353–62.PubMedCrossRef

79.

Young Jr WF. Adrenal causes of hypertension: pheochromocytoma and primary aldosteronism. Rev Endocr Metab Disord. 2007;8:309–20.PubMedCrossRef

80.

Stowasser M, Gordon RD. Familial hyperaldosteronism. J Steroid Biochem Mol Biol. 2001;78:215–29.PubMedCrossRef

81.

Stowasser M. Update in primary aldosteronism. J Clin Endocrinol Metab. 2009;94:3623–30.PubMedCrossRef

82.

Gilbert JW, Bell NH, Bartter FC. Primary aldosteronism: diagnosis and surgical treatment. Ann Surg. 1963;158:195–204.PubMedCrossRef

83.

George JM, Wright L, Bell NH, Bartter FC. The syndrome of primary aldosteronism. Am J Med. 1970;48:343–56.PubMedCrossRef

84.

Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, et al. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med. 1979;90:386–95.PubMed

85.

Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab. 2009;94:2437–45.PubMedCrossRef

86.

Karagiannis A, Tziomalos K, Kakafika AI, Athyros VG, Harsoulis F, Mikhailidis DP. Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas. Endocr Relat Cancer. 2008;15:693–700.PubMedCrossRef

87.

Brown JJ, Davies DL, Ferriss JB, Fraser R, Haywood E, Lever AF, et al. Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin. Br Med J. 1972;2:729–34.PubMedCrossRef

88.

Biglieri EG, Schambelan M. Management of primary aldosteronism. In: Onesti G, Kim KE, Moyer JH, editors. Hypertension: mechanisms and management. New York: Grune and Stratton; 1973. p. 493–8.

89.

Ferriss JB, Beevers DG, Boddy K, Brown JJ, Davies DL, Fraser R, et al. The treatment of low-renin (“primary”) hyperaldosteronism. Am Heart J. 1978;96:97–109.PubMedCrossRef

90.

Ghose RP, Hall PM, Bravo EL. Medical management of aldosterone-producing adenomas. Ann Intern Med. 1999;131:105–8.PubMed

91.

Sywak M, Pasieka JL. Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism. Br J Surg. 2002;89:1587–93.PubMedCrossRef

92.

Craft J. Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure. Proc (Bayl Univ Med Cent). 2004;17:217–20.

Titel: Treatment of primary aldosteronism: Where are we now?
verfasst von: Asterios Karagiannis
Publikationsdatum: 01.03.2011
Verlag: Springer US
Erschienen in: Reviews in Endocrine and Metabolic Disorders / Ausgabe 1/2011
Print ISSN: 1389-9155
Elektronische ISSN: 1573-2606
DOI: https://doi.org/10.1007/s11154-011-9159-3

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