Diagnosis and treatment of primary hyperaldosteronism

Abstract

Sixty-two patients (mean age 45.1±9.3 years) with primary hyperaldosteronism (PHA), including 37patients with aldosterone-pro- ducing adenoma (APA) and 25patients with idiopathic hyperaldosteronism (IHA), were examined. The patients’ daily urinary ex­cretion of adrenal hormones (aldosterone, cortisol, epinephrine, norepinephrine) and the peripheral blood levels of hormones (aldos­terone, renin) were determined. Topical diagnosis was made by ultrasonography, computed tomography, magnetic resonance imaging, angiography, including that with selective blood sampling from the supraadrenal veins. Some patients underwent daily blood pressure (BP) monitoring. The combined antihypertensive therapy included spirolactone, calcium antagonists, that for patients with IHA in­volved angiotensin-converting enzyme (ACE) inhibitors and angiotensin I (ATJ receptor blockers. Surgery was made in 47 (77.4%) patients, including 37 (59.7%)) and 11 (17.7%) patients for APA and IHA, respectively. In all the cases, the result of a pathohistological study corresponded to the preoperative diagnosis. In all the patients (those with APA received preoperative preparation and those with IHA had constant conservative therapy), target blood pressure was achieved by a combined antihypertensive therapy using spiro­lactone, 100-250 mg/day and dihydropiridine calcium antagonists. There was evidence for the efficacy of the ACE inhibitor lysinopril, 10-20 mg/day, and AT_t receptor blocker losarthan, 50-100 mg/day, used in combined therapy for IHA