Biomarkers to Guide Medical Therapy in Primary Aldosteronism.

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Endocrine reviews Pub Date : 2024-01-04 DOI:10.1210/endrev/bnad024
Gregory L Hundemer, Alexander A Leung, Gregory A Kline, Jenifer M Brown, Adina F Turcu, Anand Vaidya
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Abstract

Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin-biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.

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指导原发性醛固酮增多症药物治疗的生物标志物。
原发性醛固酮增多症(PA)是一种以醛固酮分泌失调为特征的内分泌疾病,尽管肾素和血管紧张素II受到抑制,但仍会发生,并且不受容量和钠负荷的抑制。手术切除肾上腺对侧化PA患者的有效性表现为减少过量醛固酮产生导致血压降低、纠正低钾血症和肾素升高;这些生物标志物共同表明PA病理生理的逆转和正常生理的恢复。尽管绝大多数PA患者最终将接受药物治疗而不是手术治疗,但缺乏关于如何优化药物治疗和成功的关键指标的指导。在此,我们回顾了证明PA医学管理方法和生物标志物的证据,这些生物标志物反映了恢复正常生理的内分泌原理。我们回顾了目前的医学治疗方法,包括饮食钠限制,甾体和非甾体矿物皮质激素受体拮抗剂,上皮钠通道抑制剂和醛固酮合成酶抑制剂。至关重要的是,临床医生认识到,当有意滴定时,PA的多模式医学治疗可以非常有效地降低心血管和肾脏不良后果的风险。反映优化药物治疗的关键生物标志物与肾上腺切除术后的生理预期相似:使用最少数量的降压药控制血压,无需补充血清钾正常化,肾素升高。审查了在减轻不利影响的同时实现这些目标的务实方法。
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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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