일차성 알도스테론증
Primary Aldosteronism
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참고문헌
키워드
초록
PA는 전체 고혈압 환자의 10% 내외로 추정되며 완치가가능한 고혈압의 가장 흔한 원인이다. 앞에서 살펴본 내용을중심으로 진단 및 치료에 대한 알고리듬을 그림 1에서 제시하였다. 진단을 위해서는 ARR의 증가와 후속적인 알도스테론 억제 검사가 요구된다. 원인 질환의 감별은 치료를 위해필수적이며 부신 CT가 진단에 제한점이 있으므로 수술을 고려하는 환자들에서 부신 정맥 채혈이 추천된다. APA의 치료로는 일측성 복강경 부신절제술이 적절하며 약물학적 치료로 MRA의 사용이 추천된다.
Abstract
Primary aldosteronism (PA) is characterized by inappropriately high production of aldosterone relatively autonomous from the renin-angiotensin system and no suppression by sodium loading. The prevalence of PA is estimated more than 10% among nonseleted hypertensive patients. PA is clinically very important since patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential hypertension and the same degree of blood pressure elevation. The ratio of plasma aldosterone concentration to plasma renin activity (ARR) has been generally accepted as a first-line screening test. ARR might be affected by patient age, anti-hypertensive drugs, posture and menstrual cycles. Once the ARR is measured, confirmative test should be performed. Although a gold standard confirmative test for PA is not yet identified, intravenous saline loading test is widely used. Adrenal venous sampling (AVS) is a gold standard for differentiation of unilateral from bilateral forms of PA. Since adrenal CT imaging has limitations to accurate diagnosis of PA, AVS is recommended for all patients who wish to pursue surgical treatment. Although unilateral laparoscopic adernalectomy is the optimal treatment for patients with aldosterone producing adenoma or unilateral hyperplasia, strong evidence linking adernalectomy with improved quality of life, morbidity or mortality is not available. Mneralocorticoid receptor antagonists, spironolactone or eplerenone, are recommended for pharmacologic therapy of PA. (Korean J Med 2012;82:396-402)
참고문헌 (31)
- Conn JW, "Presidential address: I. painting background: II. primary aldosteronism, a new clinical syndrome", J Lab Clin Med, 45, pp.3~17 (1955)
- Funder JW, "Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline", J Clin Endocrinol Metab, 93, pp.3266~3281 (2008)
- Fardella CE, "Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology", J Clin Endocrinol Metab, 85, pp.1863~1867 (2000)
- Mulatero P, "Drug effects on aldosterone", plasma renin activity ratio in primary aldosteronism, 2002, pp.40, 897~902
- Rossi E, "High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives", Am J Hypertens, 15(10 Pt 1), pp.896~902 (2002)
- Brown NJ., "Aldosterone and end-organ damage", Curr Opin Nephrol Hypertens, 14, pp.235~241 (2005)
- Milliez P, "Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism", J Am Coll Cardiol, 45, pp.1243~1248 (2005)
- Pitt B, "Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction", N Engl J Med, 348, pp.1309~1321 (2003)
- Zannad F, "Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the randomized aldactone evaluation study (RALES): Rales Investigators", Circulation, 102, pp.2700~2706 (2000)
- Fallo F, "Prevalence and characteristics of the metabolic syndrome in primary aldosteronism", J Clin Endocrinol Metab, 91, pp.454~459 (2006)
- Mattsson C, "Primary aldosteronism: diagnostic and treatment strategies", Nat Clin Pract Nephrol, 2, pp.198~208 (2006)
- Young WF, "Primary aldosteronism: renaissance of a syndrome", Clin Endocrinol (Oxf), 66, pp.607~618 (2007)
- Oelkers WK., "Effects of estrogens and progestogens on the renin-aldosterone system and blood pressure", Steroids, 61, pp.166~171 (1996)
- Fommei E, "The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women", J Hum Hypertens, 23, pp.130~135 (2009)
- Ferrari P, "Active renin versus plasma renin activity to define aldosterone-torenin ratio for primary aldosteronism", J Hypertens, 22, pp.377~381 (2004)
- Olivieri O, "Aldosterone to Renin ratio in a primary care setting: the Bussolengo Study", J Clin Endocrinol Metab, 89, pp.4221~4226 (2004)
- Unger N, "Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass", Eur J Endocrinol, 150, pp.517~523 (2004)
- Nishikawa T, "Guidelines for the diagnosis and treatment of primary aldosteronism: the Japan Endocrine Society 2009", Endocr J, 58, pp.711~721 (2011)
- Cicala MV, "Primary aldosteronism: what consensus for the diagnosis", Pract Res Clin Endocrinol Metab, 24, pp.915~921 (2010)
- Kempers MJ, "Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism", Ann Intern Med, 151, pp.329~337 (2009)
- Stewart PM, "Adrenal vein sampling for primary aldosteronism: time for a reality check", Clin Endocrinol (Oxf), 72, pp.146~148 (2010)
- 이지선, "발성 알도스테론증 환자에서 부신정맥채혈의 의의 및 문제점", Endocrinology and Metabolism, 22(6), pp.428~435 (2007), 대한내분비학회
- Young WF, "What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism?", Clin Endocrinol (Oxf), 70, pp.14~17 (2009)
- Meyer A, "Long-term follow-up after adrenalectomy for primary aldosteronism", World J Surg, 29, pp.155~159 (2005)
- Sawka AM, "Primary aldosteronism: factors associated with normalization of blood pressure after surgery", Ann Intern Med, 135, pp.258~261 (2001)
- Sywak M, "Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism", Br J Surg, 89, pp.1587~1593 (2002)
- Celen O, "Factors influencing outcome of surgery for primary aldosteronism", Arch Surg, 131, pp.646~650 (1996)
- Proye CA, "Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?", Surgery, 124, pp.1128~1133 (1998)
- Jeunemaitre X, "Efficacy and tolerance of spironolactone in essential hypertension", Am J Cardiol, 60, pp.820~825 (1987)
- Zannad F, "Eplerenone in patients with systolic heart failure and mild symptoms", N Engl J Med, 364, pp.11~21 (2011)
- Dluhy RG, "Glucocorticoid-remediable aldosteronism", Clin Endocrinol Metab, 84, pp.4341~4344 (1999)