Información del artículo
El hiperaldosteronismo primario es la causa principal de hipertensión secundaria. Su presentación inicial ha cambiado y presenta normopotasemia como expresión de formas hormonales más leves (hiperplasia adrenal idiopática bilateral).
Presentamos un caso de hiperaldosteronismo primario en un hombre de 71 años de edad, sin hipertensión, que presentó debilidad muscular y una concentración de potasio plasmático de 2,6 mEq/l.
El diagnóstico requiere ser confirmado mediante una sobrecarga salina o una prueba con fludrocortisona. La caracterización de los subtipos se realiza con pruebas de imagen y una prueba postural, valoradas conjuntamente.
La espironolactona es la base del tratamiento médico cuando la intervención quirúrgica no está indicada o cuando el paciente la rechaza. Próximamente, el tratamiento del hiperaldosteronismo primario puede modificarse con un nuevo antagonista selectivo de los receptores de la aldosterona, la eplerenona.
Palabras clave:
Hipopotasemia
Aldosterona
Hiperaldosteronismo
Primary hyperaldosteronism is the primary cause of secondary hypertension. Its initial presentation has changed so that is usually manifests with normokalemia as reflection of a milder hormonal forms of the disease (idiopathic bilateral adrenal hyperplasia).
We report a case of primary hyperaldosteronism in a 71-yearold man without hypertension who presented with muscular weakness. The kalemia was 2.6 mEq/l.
The diagnosis requires confirmation by a salt loading or fludrocortisone test. Characterization of subtypes is achieved by joint assessment of imaging and postural stimulation tests.
Spironolactone is still the basis of medical treatment when surgery is not indicated or is refused by the patient. In the near future, the treatment of primary hyperaldosteronism may be modified by a new selective aldosterone receptor antagonist, eplerenone.
Key words:
Hypokalemia
Aldosterone
Hyperaldosteronism
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Bibliografía
[1.]
J.W. Conn.
Presidential address. Part I painting background: part II primary aldosteronism, a new clinical syndrome.
J Lab Clin Med, 45 (1995), pp. 3
[2.]
N.M. Kaplan.
Cautins over the current epidemic of primary aldosteronism.
Lancet, 357 (2001), pp. 953-954
[3.]
A. Ganguly.
Primary aldosteronism.
N Engl J Med, 339 (1998), pp. 1828-1834
[4.]
M. Stowasser.
Primary aldosteronim: revival of a syndrome [editorial].
J Hypertens, 19 (2001), pp. 363-366
[5.]
R.D. Gordon.
Mineralcorticoid hypertension.
Lancet, 23 (1994), pp. 240-243
[6.]
R.W. Edwards Cristopher.
Primary mineralocorticoid excess syndromes.
Endocrinology 4th ed, pp. 1820-1844
[7.]
M. Matsunaga, A. Hara, T.S. Song, M. Hashimoto, S. Tamori, K. Ogawa, et al.
Asyntomatic normotensive primary aldosteronism. Case report.
Hypertension, 5 (1983), pp. 240-243
[8.]
C.E. Fardella, L. Mosso, C.E. Gómez Sánchez, P. Cortes, J. Soto, L. Gómez, et al.
Primary hyperldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology.
J Clin Endocrinol Metab, 85 (2000), pp. 1863-1867
[9.]
R.D. Gordon.
Primary aldosteronism (views).
J Endocrinol Invest, 18 (1995), pp. 495-511
[10.]
P.O. Lim, W.F. Young, T.M. McDonald.
A review of the medical treatment of primary aldosteronism.
J Hyperts, 19 (2001), pp. 353-361
[11.]
M.H. Weinberger, N.S. Fineberg.
The diagnosis of primary aldosteronism and separation of two major subtypes.
Arch Intern Med, 153 (1993), pp. 2125-2130
[12.]
D. Hirohara, K. Nomura, T. Kamoto, M. Ujihara, K. Takano.
Performance of the basal aldosterone to renin action and the of renin stimulation test by furosemide and upright posture in screening for aldosterone-producing adenoma in low renin hypertensives.
J Clin Endocrinol Metab, 86 (2001), pp. 4292-4298
[13.]
W.F. Young, N.M. Kaplan, B.D. Roese.
Approach to the patient with hypertension and hypokalemia.
Up To Date [revista electrónica], 9 (2001),
[14.]
A. Ganguly.
Prevalence of primary aldosteronism in unselected hypertensive populations: screening and definitive diagnosis.
J Clin Endocrinol Metab, 86 (2001), pp. 4002-4003
[15.]
J.r. Young WF.
Minireview: primary aldosteronism. Changing concepts in diagnosis and treatment.
Endocrinology, 144 (2003), pp. 2208-2213
[16.]
A.J. Pérez Pérez.
Hiperaldosteronismo primario: subtipos y diagnóstico de localización [editorial].
Hipertensión, 18 (2001), pp. 257-262
[17.]
J.B. Ferriss, D.G. Beevers, J.J. Brown, D.L. Davies, R. Fraser, A.F. Lever, et al.
Clinical, biochemical and pathological features of low-renin (“primary”) hyperaldosteronism.
Am Heart J, 95 (1978), pp. 375-388
[18.]
S. Abdelhamid, H. Müller-Lobeck, S. Pahl, K. Remberger, J.A. Bönhof, D. Walb, et al.
Prevalence of adrenal and extra-adrenal Conn syndrome in hypertensive patients.
Arch Intern Med, 56 (1996), pp. 1190-1195
[19.]
I. Irony, C.E. Kater, E.G. Biglieri, C.H.L. Shackelton.
Correctable subsets of primary aldosteronism: primary adrenal hyperplasia and renin responsive adenoma.
Am J Hypertens, 3 (1990), pp. 576-582
[20.]
T.J. Tunny, R.D. Gordon, S.A. Klem, D. Cohn.
Histological and biochemical distinctiveness of atypical aldosterone-producing adenomas responsive to upright posture and angiotensin.
Clin Endocr, 34 (1991), pp. 363-369
[21.]
E. Lurbe, F.J. Chaves, I. Torró, M.E. Armengod, V. Álvarez, J. Redón.
Hiperaldosteronismo remediable con glucocorticoides: diagnóstico genético.
Med Clin (Barc), 113 (1999), pp. 579-582
[22.]
R.G. Dluhy, R.P. Lifton.
Glucocorticoid-remediable aldosteronism.
Endocrinol Metab Clin North Am, 23 (1994), pp. 285-297
[23.]
W.R. Lichfield, B.F. Anderson, R.J. Weiss, R.P. Lifton, R.G. Dluhy.
Intracranial aneurysm and hemorragic stroke in glucocorticoidremediable aldosteronism.
Hypertension, 31 (1998), pp. 445-450
[24.]
D.J. Torpy, R.D. Gordon, J.P. Lin, P.R. Huggard, S.E. Taymans, M. Stowasser, et al.
Familial hyperaldosteronism type II: description a large kindred and exclusion of the aldosterone synthase (CYP11B2) gene.
J Clin Endocrinol Metab, 83 (1998), pp. 3214-3218
[25.]
J.D. Blumenfeld, J.E. Sealey, Y. Schlussel, E.D. Vaughan Jr, T.A. Sos, S.A. Atlas, et al.
Diagnosis and treatment of primary aldosteronism.
Ann Intern Med, 121 (1994), pp. 877-885
[26.]
S.B. Magill, H. Raff, J.L. Shaker, R.C. Brickner, T.E. Knechtges, M.E. Kehoe, et al.
Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism.
J Clin Endocrinol Metab, 86 (2001), pp. 1066-1071
[27.]
F.A. McAlister, R.Z. Lewanczuk.
Primary hyperaldosteronism and adrenal incidentaloma: an argument for physiologic testing before adrenalectomy.
Can J Surg, 41 (1998), pp. 299-305
[28.]
R.G. Fontes, C.E. Kater, E.G. Biglieri, I. Irony.
Reassessment of the predictive value of the postural stimulation test in primary aldosteronism.
Am J Hypertens, 4 (1991), pp. 786-791
[29.]
K. Nomura, K. Kusakabe, M. Maki, Y. Ito, M. Aiba, H. Demura.
Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone-supression scintigraphy: relationship to adenoma size and funcional activity.
J Clin Endocrinol Metab, 71 (1990), pp. 825-830
[30.]
J.L. Doppman, J.R. Gill.
Hyperaldosteronism: sampling the adrenal veins (how I do it).
Radiology, 198 (1996), pp. 309-312
[31.]
G.P. Rossi, A. Sachetto, M. Chiesura-Corona, R. De Toni, M. Gallina, G.P. Feltrin, et al.
Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases.
J Clin Endocrinol Metab, 86 (2001), pp. 1083-1090
[32.]
R. Harper, C.G. Ferret, J.A. McKnight, E.M. Mcllrath, C.F. Russell, B. Sheridan, et al.
Accuracy of CT scanning and adrenal vein sampling in the pre-operative localization of aldosterone-secreting adrenal adenomas.
QJM, 92 (1999), pp. 643-650
[33.]
R. Rocha, J.W. Funder.
The pathophysiology of aldosterone in the cardiovascular system.
Ann NY Acad Sci, 970 (2002), pp. 89-100
[34.]
J.r. Stier CT, P.N. Chander, R. Rocha.
Aldosterone as a mediator in cardiovascular injury.
Cardiol Rev, 10 (2002), pp. 97-107
[35.]
C.G. Brilla, R. Pick, L.B. Tan, J.S. Janicki, K.T. Weber.
Remodeling of the rat right and left ventricles in experimental hypertension.
Circ Res, 67 (1990), pp. 1355-1364
[36.]
B. Pitt, F. Zannad, W.J. Remme, R. Cody, A. Castaigne, A. Pérez, et al.
The effect of spironolactone on morbidity and mortality in patients with severe heart failure.
N Engl J Med, 341 (1999), pp. 709-717
[37.]
N.J. Brown, M.A. Agirbasli, G.H. Willians, W.R. Litchfield, D.E. Vaughan.
Effect of activation and inhibition of the renin angiotensin system on plasma PAI 1.
Hypertension, 32 (1998), pp. 965-971
[38.]
P. Meria, B.F. Kempf, J.F. Heermieu, P.F. Plouin, J.M. Duclos.
Laparoscopic management of primary aldosteronism: clinical experience with 212 cases.
J Urol, 169 (2003), pp. 32-35
[39.]
A.M. Sawka, W.F. Young Jr, G.B. Thompson, C.S. Grant, D.R. Farley, C. Leibson, et al.
Primary aldosteronism: fators associated with normalization of blod pressure after surgery.
Ann Intern Med, 135 (2001), pp. 258-261
[40.]
Y. Fukudome, K. Fujii, H. Arima, Y. Ohya, T. Tsuchihashi, I. Abe, et al.
Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy.
Hypertens Res, 25 (2002), pp. 11-18
[41.]
P.A. Almeida, F. Costa Alves, P.O. Pinto, M.M. Diniz, G. Pego, L.A. Providencia.
First results in 34 patients with primary aldosteronism treated by CT-guided percutaneous ethanol [resumen].
Am J Hipertens, 14 (2001), pp. 251A
[42.]
X. Jeunemaitre, G. Chatellier, C. Kreft-Jais, A. Charru, C. De Vries, P.F. Plouin, et al.
Efficacy and tolerance of spironolatone in essential hypertension.
Am J Cardiol, 60 (1987), pp. 820-825
[43.]
M. De Gasparo, U. Joss, H.P. Ramjoue, S.E. Whitebread, H. Haenni, L. Schenkel, et al.
Three new epoxy-spironolactone derivates: characterization in vivo and in vitro.
J Pharmacol Exp Ther, 240 (1987), pp. 650-656
[44.]
M. Stowasser, A.W. Bachman, P.R. Huggard, T.R. Rossetti, R.D. Gordon.
Treatment of familial hyperaldosteronism type I: only partial suppression of adrenocorticotropin required to correct hypertension.
J Clin Endocrinol Metab, 85 (2000), pp. 3313-3318
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