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Vol. 155. Issue 7.
Pages 302-308 (October 2020)
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Vol. 155. Issue 7.
Pages 302-308 (October 2020)
Review
Treatment of primary hyperaldosteronism
Tratamiento del hiperaldosteronismo primario
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Marta Araujo-Castro
Unidad de Neuroendocrinología, Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Tables (4)
Table 1. Preparation, protocols and interpretation of adrenal vein catheterization.
Table 2. General indications for drug therapy in primary hyperaldosteronism.
Table 3. Drug therapy in primary hyperaldosteronism.46
Table 4. Special situations in primary hyperaldosteronism.
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Abstract

Primary aldosteronism is associated with higher cardiovascular and renal morbidity and mortality than essential hypertension in age- and sex-matched patients with the same degree of blood pressure elevation. Therefore, it is essential to establish a specific treatment to avoid the deleterious effects of aldosterone excess. Although adrenalectomy is generally considered the treatment of choice in cases of primary aldosteronism due to unilateral disease, several aspects and circumstances should be taken into account that may make medical treatment more appropriate. Among them, in this review we mention the limited experience and efficacy, and the potential risks of adrenal vein sampling; the risks and low efficacy of adrenalectomy; the high safety and efficacy of medical treatment and some special situations such as primary aldosteronism during pregnancy, in patients of advanced age or hereditary forms of primary aldosteronism, in which medical treatment is considered especially indicated as the first line therapy. The main studies comparing medical and surgical treatment in primary aldosteronism are also discussed.

Keywords:
Primary hyperaldosteronism
Adrenal vein sampling
Adrenalectomy
Spironolactone
Eplerenone
Resumen

El hiperaldosteronismo primario (HAP) se asocia con una mayor morbimortalidad cardiovascular y renal que la hipertensión arterial (HTA) esencial, a misma edad, sexo y grado de HTA. Por ello, es esencial instaurar un tratamiento específico para aminorar los efectos deletéreos del exceso de aldosterona. Aunque se considera que la adrenalectomía es generalmente el tratamiento de elección en los casos de HAP por enfermedad unilateral, se deben tener en cuenta varios aspectos y circunstancias que pueden hacer más adecuado el tratamiento médico. Entre ellos, en esta revisión se mencionan, la limitada experiencia y eficacia, y los riesgos del cateterismo de venas adrenales; los riesgos y baja eficacia de la adrenalectomía; la elevada seguridad y eficacia del tratamiento médico y algunas situaciones especiales como el embarazo, la edad avanzada o las formas familiares, en las que el tratamiento médico se considera especialmente indicado como primera línea. También se comentan los principales estudios que comparan el tratamiento médico y quirúrgico en el HAP.

Palabras clave:
Hiperaldosteronismo primario
Cateterismo de venas adrenales
Adrenalectomía
Espironolactona
Eplerenona

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