Enfermedades de la secreción de aldosterona

  1. Ituguerri Guevara, M. 1
  2. Larrán Escandón, L. 1
  3. López Tinoco, C. 2
  1. 1 Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
  2. 2 Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España Departamento de Medicina, Universidad de Cádiz, Cádiz, España
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2020

Título del ejemplar: Enfermedades endocrinológicas y metabólicas (VII)Patología suprarrenal

Serie: 13

Número: 19

Páginas: 1072-1082

Tipo: Artículo

DOI: 10.1016/J.MED.2020.10.012 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

El hiperaldosteronismo y el hipoaldosteronismo responden a una secreción excesiva o insuficiente de aldosterona, respectivamente, por las glándulas suprarrenales. Las causas más frecuentes de hiperaldosteronismo primario incluyen la hiperplasia bilateral idiopática y el adenoma productor de aldosterona. El hipoaldosteronismo hiporreninémico es la causa más frecuente de hipoaldosteronismo aislado. El hiperaldosteronismo primario se caracteriza por hipertensión arterial, hipopotasemia y alcalosis metabólica y el hipoaldosteronismo por hiperpotasemia y acidosis metabólica. El cribado del hiperaldosteronismo primario consiste en la medición del cociente aldosterona/actividad de renina plasmática (ARP). Si resulta elevado, se recomiendan pruebas funcionales (sobrecarga salina intravenosa u oral, supresión con fludrocortisona o captopril). Una vez confirmado el diagnóstico, se debe realizar un estudio de imagen mediante tomografía computarizada (TC) abdominal y, en pacientes candidatos a cirugía, cateterismo de venas adrenales. En el hipoaldosteronismo se debe demostrar la incapacidad de secreción de renina y aldosterona tras pruebas funcionales estimuladoras (cambios posturales y depleción de volumen). En el hiperaldosteronismo primario por hiperplasia o adenoma unilateral, se recomienda adrenalectomía laparoscópica unilateral; cuando la afectación es bilateral y en pacientes desestimados para cirugía, se realizará tratamiento con antagonistas del receptor mineralocorticoide-espironolactona como primera elección. En el hipoaldosteronismo, restricción de potasio y terapia mineralocorticoide sustitutiva con fludrocortisona.

Referencias bibliográficas

  • J.W. Funder , R.M. Carey, F. Mantero, M.H. Murad, M. Reincke, H. Shibata, et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An endocrine society clinical practice guideline J Clin Endocrinol Metab., 101 (5) (2016), pp. 1889-1916
  • A. Hannemann , H. Wallaschofski Prevalence of primary aldosteronism in patient's cohorts and in population-based studies-- a review of the current literature Horm Metab Res., 44 (3) (2012), pp. 157-162
  • S. Douma , K. Petidis, M. Doumas, P. Papaefthimiou, A. Triantafyllou, N. Kartali, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study Lancet., 371 (9628) (2008), pp. 1921-1926
  • P. Mulatero , D. Tizzani, A. Viola, C. Bertello, S. Monticone, G. Mengozzi, et al. Prevalence and characteristics of familial hyperaldosteronism: the PATOGEN study (Primary Aldosteronism in TOrino-GENetic forms) Hypertension., 58 (5) (2011), pp. 797-803
  • R.P. Lifton , R.G. Dluhy, M. Powers, G.M. Rich, M. Gutkin, F. Fallo, et al. Hereditary hypertension caused by chimaeric gene duplications and ectopic expression of aldosterone synthase Nature Genetics., 2 (1) (1992), pp. 66-74
  • W.R. Litchfield , C. Coolidge, P. Silva, R.P. Lifton, F. Fallo, G.H. Williams, et al. Impaired potassium-stimulated aldosterone production: a possible explanation for normokalemic glucocorticoid-remediable aldosteronism J Clin Endocrinol Metab., 82 (5) (1997), pp. 1507-1510
  • A. Pallauf , C. Schirpenbach, O. Zwermann, E. Fischer, M. Morak, E. Holinski-Feder, et al. The prevalence of familial hyperaldosteronism in apparently sporadic primary aldosteronism in Germany: a single center experience Horm Metab Res., 44 (3) (2012), pp. 215-220
  • M. Choi , U.I. Scholl, P. Yue, P. Bjorklund, B. Zhao, C. Nelson-Williams, et al. K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension Science., 331 (6018) (2011), pp. 768-772
  • G. Daniil , F.L. Fernandes-Rosa, J. Chemin, I. Blesneac, J. Beltrand, M. Polak, et al. CACNA1H mutations are associated with different forms of primary aldosteronism EBioMedicine., 13 (2016), pp. 225-236
  • P. Milliez , X. Girerd, P.-F. Plouin, J. Blacher, M.E. Safar, J.-J. Mourad Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism J Am Coll Cardiol., 45 (8) (2005), pp. 1243-1248
  • M. Stowasser , J. Sharman, R. Leano, R.D. Gordon, G. Ward, D. Cowley, et al. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I J Clin Endocrinol Metab., 90 (9) (2005), pp. 5070-5076
  • A. Markou , T. Pappa, G. Kaltsas, A. Gouli, K. Mitsakis, P. Tsounas, et al. Evidence of primary aldosteronism in a predominantly female cohort of normotensive individuals: a very high odds ratio for progression into arterial hypertension J Clin Endocrinol Metab., 98 (4) (2013), pp. 1409-1416
  • P. Mulatero , M. Stowasser, K.-C. Loh, C.E. Fardella, R.D. Gordon, L. Mosso, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents J Clin Endocrinol Metab., 89 (3) (2004), pp. 1045-1050
  • G.P. Rossi , G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients J Am Coll Cardiol., 48 (11) (2006), pp. 2293-2300
  • S. Monticone , F. D’Ascenzo, C. Moretti, T.A. Williams, F. Veglio, F. Gaita , et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis Lancet Diabetes Endocrinol., 6 (1) (2018), pp. 41-50
  • G. Hanslik , H. Wallaschofski, A. Dietz, A. Riester, M. Reincke, B. Allolio, et al. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry Eur J Endocrinol., 173 (5) (2015), pp. 665-675
  • W. Arlt , K. Lang, A.J. Sitch, A.S. Dietz, Y. Rhayem, I. Bancos, et al. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism JCI Insight., 2 (8) (2017), p. e93136
  • W.F. Young Diagnosis and treatment of primary aldosteronism: practical clinical perspectives J Intern Med., 285 (2) (2019), pp. 126-148
  • W.F. Young Primary aldosteronism: renaissance of a syndrome Clin Endocrinol., 66 (5) (2007), pp. 607-618
  • L. Mosso , C. Carvajal, A. González, A. Barraza, F. Ávila, J. Montero, et al. Primary aldosteronism and hypertensive disease Hypertension., 42 (2) (2003), pp. 161-165
  • T.A. Williams , M. Reincke Management of endocrine disease: Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited Eur J Endocrinol., 179 (1) (2018), pp. R19-R29
  • J. Morera , Y. Reznik Management of endocrine disease: The role of confirmatory tests in the diagnosis of primary aldosteronism Eur J Endocrinol., 180 (2) (2019), pp. R45-R58
  • M. Stowasser , A.H. Ahmed, D. Cowley, M. Wolley, Z. Guo, B.C. McWhinney, et al.Comparison of seated with recumbent saline suppression testing for the diagnosis of primary aldosteronism J Clin Endocrinol Metab., 103 (11) (2018), pp. 4113-4124
  • M.L.V. Lahera Vargas Hiperaldosteronismo primario En: Manual de Endocrinología y Nutrición de la SEEN [Internet] (2015) Disponible en: http://manual.seen.es/home/init
  • P. Mulatero , C. Bertello, C. Garrone, D. Rossato, G. Mengozzi, A. Verhovez, et al. Captopril test can give misleading results in patients with suspect primary aldosteronism Hypertension., 50 (2007), pp. e26-e27
  • C. Hambling , R.T. Jung, A. Gunn, M.C. Browning, W.A. Bartlett Re-evaluation of the captopril test for the diagnosis of primary hyperaldosteronism Clin Endocrinol., 36 (5) (1992), pp. 499-503
  • K. Nanba , T. Tamanaha, K. Nakao, S.-T. Kawashima, T. Usui, T. Tagami, et al. Confirmatory testing in primary aldosteronism J Clin Endocrinol Metab., 97 (5) (2012), pp. 1688-1694
  • T. Nishikawa , M. Omura, F. Satoh, H. Shibata, K. Takahashi, N. Tamura, et al. Guidelines for the diagnosis and treatment of primary aldosteronism--the Japan Endocrine Society 2009 Endocr J., 58 (9) (2011), pp. 711-721
  • V. Lim , Q. Guo, C.S. Grant, G.B. Thompson, M.L. Richards, D.R. Farley, et al. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism J Clin Endocrinol Metab., 99 (8) (2014), pp. 2712-2719
  • M.J.E. Kempers , J.W.M. Lenders, L. van Outheusden, G.J. van der Wilt, L.J. Schultze Kool, A.R.M.M. Hermus, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism Ann Intern Med., 151 (5) (2009), pp. 329-337
  • O. Vonend , N. Ockenfels, X. Gao, B. Allolio, K. Lang, K. Mai, et al. Adrenal venous sampling: evaluation of the German Conn's registry Hypertension., 57 (5) (2011), pp. 990-995
  • A. Harvey , G. Kline, J.L. Pasieka Adrenal venous sampling in primary hyperaldosteronism: comparison of radiographic with biochemical success and the clinical decision-making with “less than ideal” testing Surgery., 140 (6) (2006), pp. 845-847
  • W.F. Young , A.W. Stanson What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol., 70 (1) (2009), pp. 14-17
  • G. Kline , D.T. Holmes Adrenal venous sampling for primary aldosteronism: laboratory medicine best practice J Clin Pathol., 70 (11) (2017), pp. 911-916
  • I. Christakis , J.A. Livesey, G.P. Sadler, R. Mihai Laparoscopic adrenalectomy for Conn's syndrome is beneficial to patients and is cost effective in England J Invest Surg., 31 (4) (2018), pp. 300-306
  • M. Sywak , J.L. Pasieka Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism Br J Surg., 89 (12) (2002), pp. 1587-1593
  • B. Lechner , K. Lechner, D. Heinrich, C. Adolf, F. Holler, H. Schneider, et al. Therapy of endocrine disease: Medical treatment of primary aldosteronism Eur J Endocrinol., 181 (4) (2019), pp. R147-R153
  • C. Wilczynski , L. Shah, M.A. Emanuele, N. Emanuele, A. Mazhari Selective hypoaldosteronism: a review Endocr Practice., 21 (8) (2015), pp. 957-965
  • L.A.P. Vilela , M.Q. Almeida Diagnosis and management of primary aldosteronism Arch Endocrin Metab., 61 (3) (2017), pp. 305-312
  • F.T. Lee , D. Elaraj Evaluation and management of primary hyperaldosteronism Surg Clin N Am., 99 (4) (2019), pp. 731-745
Fuente de los datos: Dialnet