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Inicio Medicina Clínica (English Edition) Diagnosis of primary hyperaldosteronism
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Vol. 158. Issue 9.
Pages 424-430 (May 2022)
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Vol. 158. Issue 9.
Pages 424-430 (May 2022)
Review
Diagnosis of primary hyperaldosteronism
Diagnóstico del hiperaldosteronismo primario
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Marta Araujo-Castroa,
Corresponding author
marta.araujo@salud.madrid.org

Corresponding author.
, Paola Parra-Ramírezb
a Unidad de Neuroendocrinología, Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS) & Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
b Servicio de Endocrinología, Hospital La Paz, Madrid, Spain
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Table 1. Prevalence of primary hyperaldosteronism based on the screening recommendations of the European Society of Endocrinology.8
Table 2. Physiological, pathological and pharmacological factors that can affect the aldosterone/renin ratio.13
Table 3. Dynamic tests used for the confirmatory study of primary hyperaldosteronism.
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Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension. Moreover, it is associated with a higher cardio-metabolic risk than the observed in patients with essential hypertension (EHT). Therefore, a high index of clinical suspicion for PA is mandatory. If an elevated aldosterone/renin ratio is confirmed, confirmatory tests should be performed, with the exception in those patients with florid PA, with, with spontaneous hypokalaemia, plasma aldosterone> 20 ng/dl and suppressed renin, in whom this step would not be strictly necessary. Saline infusion test or captopril test are de commonly used confirmatory tests. The last step in the diagnosis of PA is the localization study, being the computerized axial tomography (CT) of the adrenal glands the initial test of choice, and adrenal venous sampling (AVS), the definitive localization test in most cases. This review summarizes the available data about the diagnosis of PA, from screening to confirmatory study and localization.

Keywords:
Primary hyperaldosteronism
Aldosterone / renin ratio
Adrenal venous sampling
Plasma aldosterone
Mineralocorticoid receptor antagonists
Resumen

El hiperaldosteronismo primario (HAP) es la forma más frecuente de hipertensión secundaria, y se asocia a un mayor riesgo cardio-metabólico que el observado en pacientes con HTA esencial. Por tanto, es preceptivo mantener un alto índice de sospecha clínica. Si se confirma un cociente aldosterona/renina elevado se deben realizar pruebas de confirmación, habitualmente una prueba de sobrecarga salina o de captopril, salvo en pacientes con HAP franco, con hipopotasemia espontánea, aldosterona plasmática >20 ng/dl y renina suprimida, en los que no sería estrictamente necesario este paso. El último paso en el diagnóstico es el estudio de localización, siendo la tomografía axial computarizada (TC) de suprarrenales la prueba inicial de elección, y el cateterismo de venas adrenales (CVA), la prueba definitiva de localización en la mayor parte de los casos. En esta revisión se resumen los datos sobre el diagnóstico del HAP, desde el cribado al estudio de confirmación y de localización.

Palabras clave:
Hiperaldosteronismo primario
Cociente aldosterona/renina
Cateterismo de venas adrenales
Aldosterona plasmática
Antagonistas del receptor de mineralocorticoides

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