Advances in Medical Treatment of Primary Aldosteronism / 中国医学科学杂志(英文版)

Primary aldosteronism (PA) is the most common form of secondary hypertension, with its main manifestations including hypertension and hypokalemia. Early identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation, stroke, and myocardial infarction. The past decade has witnessed the rapid advances in the genetics of PA, which has shed new light on PA treatment. While surgery is the first choice for unilateral diseases, bilateral lesions can be treated with mineralocorticoid receptor antagonists (MRAs). The next-generation non-steroidal MRAs are under investigations. New medications including calcium channel blockers, macrophage antibiotics, and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.

Persistent and serious hyperkalemia after surgery of primary aldosteronism: A case report / 北京大学学报(医学版)

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary aldosteronism", "hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.

Aldosterona e os sistemas cardiovascular e renal: do diagnóstico ao tratamento / Aldosterone and the cardiovascular and renal systems: from diagnosis to treatment

O sistema renina-angiotensina-aldosterona vem despertando cada vez mais interesse em relação a seus efeitos no sistema cardiovascular. Atualmente, crescentes avanços nos estudos clínico-experimentais tem proporcionado melhor esclarecimento da fisiopatologia deste sistema , com ênfase no papel da aldosterona como indutora de lesão de órgãos-alvo, por promovar inapropriada expansão da volemia, remodelamento e fibrose do sistema cardiovascular, sobretudo do coração e dos rins. No coração, a aldosterona está relacionada ao desenvolvimento de hipertrofia ventricular, fibrose e falência cardíaca. Níveis elevados de aldosterona plasmática estão associados a pior prognóstico na insuficiência cardíaca congestiva e na fase aguda do infarto agudo do miocárdio. No rim, a aldosterona promove infalmação, injúria, fibrose e alteração da hemodinâmica glomerular, com consequente aumento da proteinúria e piora progressiva da função renal. Produz, também, aletrações no metabolismo da glicose e está relacionada à obesidade e à hipertensão arterial sistêmica. Os efeitos causados pela aldosterona são mais exuberantes em pacientes com hiperaldosteronismo primário, sendo de extrema importância seu reconhecimento precoce. O uso de antagonistas da aldosterona diminui seu efeito deletério no sistema cardiovascular melhorando a sobrevida e o prognóstico dos pacientes com insuficiência cardíaca congestiva, nefropatia e hiperaldosteronismo primário.

Effect of chronic oral administration of a low dose of captopril on sodium appetite of hypothyroid rats: Influence of aldosterone treatment

Rats rendered hypothyroid by treatment with methimazole develop an exaggerated sodium appetite. We investigated here the capacity of hypothyroid rats (N = 12 for each group) to respond to a low dose of captopril added to the ration, a paradigm which induces an increase in angiotensin II synthesis in cerebral areas that regulate sodium appetite by increasing the availability of circulating angiotensin I. In addition, we determined the influence of aldosterone in hypothyroid rats during the expression of spontaneous sodium appetite and after captopril treatment. Captopril significantly increased (P<0.05) the daily intake of 1.8 percent NaCl (in ml/100 g body weight) in hypothyroid rats after 36 days of methimazole administration (day 36: 9.2 + or - 0.7 vs day 32: 2.8 + or - 0.6 ml, on the 4th day after captopril treatment). After the discontinuation of captopril treatment, daily 1.8 percent NaCl intake reached values ranging from 10.0 + or - 0.9 to 13.9 ± 1.0 ml, 48 to 60 days after treatment with methimazole. Aldosterone treatment significantly reduced (P<0.05) saline intake before (7.3 + or - 1.6 vs day 0, 14.4 + or - 1.3 ml) and after captopril treatment. Our results demonstrate that, although hypothyroid rats develop a deficiency in the production of all components of the renin-angiotensin-aldosterone system, their capacity to synthesize angiotensin II at the cerebral level is preserved. The partial reversal of daily 1.8 percent NaCl intake during aldosterone treatment suggests that sodium retention reduces both spontaneous and captopril-induced salt appetite