Hyperaldosteronism is a pathological condition resulting from increased production of aldosterone-main mineralokortikoidnogo hormone napochechnikov crust. When the primary giperaldosteronizme there is arterial hypertension, headache, cardialgia, irregular heartbeat, blurred vision, muscle weakness, parestesia, convulsions. When the secondarygiperal′dosteronizme are peripheral edema, chronic kidney failure, changes of the fundus.Diagnosis of different types of giperaldosteronizma includes biochemical analysis of blood and urine, functional stress tests, ultrasound, MRI, scintigrafiû, radio venografiû, a study ofthe heart, liver, kidney and renal arteries. Treatment of al′dosterome cancer bygiperaldosteronizma adrenal, kidney-reninome operative, when other forms of medication.
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Hyperaldosteronism
Causes giperaldosteronizma
Pathogenesis giperaldosteronizma
Symptoms giperaldosteronizma
Diagnostics giperaldosteronizma
Treatment giperaldosteronizma
Forecast and prevention of giperaldosteronizma
Hyperaldosteronism-treatment in Moscow
Hyperaldosteronism includes a variety of HIV Pathogenesis, but similar clinical signs occur with syndromes of excessive secretion of aldosterone. Hyperaldosteronism can be primary(due to pathology of the adrenal gland) and secondary (caused by hypersecretion of Reninin other diseases). Primary giperaldosteronizm diagnosed in 1-2% of patients with symptomatic arterial hypertension. In Endocrinology, 60-70% of patients with primarygiperal′dosteronizmom are women aged 30-50 years; described few casesgiperaldosteronizma among children.
Causes giperaldosteronizma
Depending on the etiological factor, there are several forms of primarygiperaldosteronizma, of which 60-70% of cases occur in Conn syndrome, the cause of which is aldosteroma-al′dosteronproduciruûŝaâ adrenal adenoma. The presence of bilateraldiffuse adrenal hyperplasia lumpy-leads to the development of idiopathicgiperaldosteronizma.
There is a rare familial form of primary giperaldosteronizma with autosomal dominantinheritance type due to a defect in the enzyme 18-hydroxylase deficiency, escaping from the control of Renin-angiotensin system and korrigiruemogo glukokortikoidami (common inpatients of young age with the high incidence of hypertension family history). In rare cases, the primary giperaldosteronizm can be caused by cancer of the adrenal gland to producealdosterone and 11-deoxycorticosterone.
Secondary giperaldosteronizm occurs as a complication of diseases of cardiovascular system, diseases of the liver and kidneys. Secondary hyperaldosteronism is observed in heart failure, malignant hypertension, cirrhosis of the liver, syndrome of barter, dysplasia and stenosis of the renal arteries, nefroticescom syndrome, reninome kidney and renal failure.
Increased Renin secretion and the development of secondary giperaldosteronizma causessodium loss (diet, diarrhea), decrease in volume of circulating blood in blood loss and dehydration, excessive intake of potassium, long-term use of certain medicines (diuretics,KOK, laxatives).
Pseudohyperaldosteronism develops when the reaction of distal renal tubules toaldosterone, which, despite its high level in blood serum is hyperkalemia.
Vnenadpočečnikovyj has frequently giperaldosteronizm, for example, in the pathology ofthe ovary, thyroid and intestines.
Pathogenesis giperaldosteronizma
Primary giperaldosteronizm (nizkoreninovyj) is usually associated with the tumor orhyperplastic lesions of the adrenal cortex and is characterized by a combination of increased secretion of aldosterone on gipokaliemiei and arterial hypertension.
The basis of the pathogenesis of primary giperaldosteronizma is the impact of excessaldosterone on vodno-elektrolitny balance: increase reabsorption of sodium ions and water in the kidney tubules and increased excretion of potassium ions in the urine, leading to fluid retention and gipervolemii, under alkalozu, lower production and plasma Renin activity. Thehemodynamics and the sensitivity of vascular wall to the action of the endogenous factorsof pressure and peripheral vascular resistance current blood. When the primary giperaldosteronizme strong and long gipokaliemičeskij syndrome leads to Dystrophicchanges in renal bone (kaliepeničeskoj nephropathy) and muscle pain.
Secondary (vysokoreninovyj) there is a compensatory, hyperaldosteronism in response toreductions in renal blood flow in various diseases of the kidneys, liver, heart. Secondaryhyperaldosteronism develops due to activation of the Renin-angiotensin system and increased production of Renin kidney machine ûkstaglomerulârnogo cells that have an excessive stimulation of the adrenal cortex. Characteristic of primary giperaldosteronizmaexpressed electrolyte disorders in secondary form does not appear.
Symptoms giperaldosteronizma
The clinical presentation of primary giperaldosteronizma reflects violations vodno-elektrolitnogo balance, caused by hypersecretion of aldosterone. Because of the delaysodium and water retention in patients with primary giperal′dosteronizmom is expressed or moderate arterial hypertension, headaches, aching pain in the heart (cardialgia), violations of heart rhythm, changes of the fundus with the deterioration of Visual function(hypertensive angiopathy, angioskleroz, retinopathy).
Potassium deficiency leads to rapid fatigue, muscle weakness, paresthesia, attacks of cramps in different groups of muscles, periodic psevdoparaličej; in the most severe cases-to the development of myocardial degeneration, kaliepeničeskoj nephropathy, diabetesinsipidus nefrogennogo. When the primary giperaldosteronizme without heart failureperipheral edema are not observed.
When the secondary giperal′dosteronizme is high blood pressure (diastolic BP > c 120 mm Hg), gradually leading to the defeat of the vascular wall tissue ischemia, and worsening ofrenal function and development of CRF, changes of the fundus (haemorrhages,nejroretinopatii). The most common symptom of secondary giperaldosteronizma areswelling, gipokaliemia occurs in rare cases. Secondary hyperaldosteronism can proceedwithout hypertension (e.g., the syndrome of barter and psevdogiperal′dosteronizme).
In some patients, there is a period of giperaldosteronizma.
Diagnostics giperaldosteronizma
Diagnosis involves the differentiation of various forms of giperaldosteronizma and determination of their etiology.
As part of the initial diagnostic analysis of the functional status of the Renin-angiotensin-aldosterone system activity with definition of aldosterone and Renin in the blood and urineat rest and after load tests, potassium-sodium balance and ACTH on aldosterone secretion.
For primary giperaldosteronizma is characterized by increased levels of serum aldosterone,plasma Renin activity decreased (RPA), high aldosterone/Renin, hypokalemia,hypernatremia, low relative density, significant increase in urine daily excretion of potassium and aldosterone in urine. The main diagnostic criterion of secondary giperaldosteronizma is an increased rate of ARP (with reninome-more than 20-30 ng/ml/hour).
To differentiate selected forms of the test are al′daktonom giperaldosteronizma(spironolactone), test with a load of gipotiazidom, "playing March" trial.
With a view to identifying marriage form giperaldosteronizma conduct genome typing by PCR. When giperal′dosteronizme, korrigiruemom glukokortikoidami, diagnostic importance is dexamethasone treatment trial (prednisolone), which are manifestations of disease, andnormalizes blood pressure.
To clarify the nature of defeat (aldosteroma, diffusive-knotted hyperplasia, cancer) usemethods of topical diagnosis: ULTRASONOGRAPHY of adrenal glands, scintigrafiû, CT scan and MRI of adrenal gland, selective venografiû with simultaneous determination ofaldosterone and cortisol levels in the blood of nadpočečnikovyh veins.
It is also important to establish the disease that caused the development of secondary giperaldosteronizma with studies of the heart, liver, kidney and renal arteries (echocg, ECG, ultrasound of liver, kidney ULTRASOUND, ULTRASONIC DOPPLEROGRAPHY and duplex scanning of the renal arteries, multislice CT, MRI-angiography).
Treatment giperaldosteronizma
The choice of method and treatment tactics giperaldosteronizma depends on the cause ofhypersecretion of aldosterone. Survey of patients is an endocrinologist, cardiologist,nefrologom, an ophthalmologist.
Medication kalisberegatmi dioretikami (spirolaktonom and amiloridom) are at different forms of giporeninemičeskogo giperaldosteronizma (adrenal hyperplasia, al′dosterome) as a preparatory stage to the operation that helps to normalize blood pressure and eliminatehypokalemia. Shows a low-salt diet is a diet with increased content in the diet of foods richin potassium, as well as the introduction of drugs potassium.
Al′dosteromy and adrenal cancer treatment is rapid, is to remove the affected adrenal gland (adrenalektomii) with preliminary restoration vodno-elektrolitnogo balance.
Patients with bilateral hyperplasia of adrenal cortex is usually treated conservatively(spironolactone, amiloride) in combination with ACE inhibitors, calcium channel antagonists(nifedipine). When hyperplastic forms giperaldosteronizma full bilateral adrenalectomy andright-sided adrenalectomy in combination with the duodenum resection of left adrenal gland are ineffective. Gipokaliemia disappears, but no desired gipotenzivny effect (hell is normalized only in 18% of cases) and there is a high risk of developing acute adrenal insufficiency.
When giperal′dosteronizme, verifiable correction glucocorticoid therapy to correcthormonal and metabolic disorders and normalization of HELL prescribe hydrocortisone ordexamethasone.
When pressed a giperal′dosteronizme combination antigipertenzivnuu therapy out against the backdrop of pathogenetic treatment of the underlying condition under the mandatorysupervision of the ECG and the level of potassium in the blood plasma.
In the case of secondary giperaldosteronizma due to stenosis of the renal arteries to normalize the blood circulation and the functioning of kidneys available for percutaneousrentgenoèndovaskulârnoj Balloon dilatation and stenting of the affected kidney artery openreconstructive surgery. When identifying kidney reninomy resected.
Forecast and prevention of giperaldosteronizma
Forecast giperaldosteronizma depends on the severity of the disease-causes, incidence ofcardiovascular and urinary system, timeliness and treatment. Radical surgical treatment oradequate medical therapy provide a high probability of recovery. Adrenal cancer prognosis is poor.
With the aim of preventing giperaldosteronizma requires continuous clinical supervision for persons with arterial hypertension, liver disease and kidney failure; adherence to medicalrecommendations for medication and diet.
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