bmjourBaikal Medical JournalБайкальский медицинский журнал2949-0715Irkutsk State Medical University10.57256/2949-0715-2022-1-11-23bmjour-22Research ArticleScientific literature reviewsНаучные обзоры литературыPRIMARY ALDOSTERONISM: CURRENT DIAGNOSTIC APPROACHПЕРВИЧНЫЙ АЛЬДОСТЕРОНИЗМ: СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕhttps://orcid.org/0000-0002-9069-3570ЕнисееваЕлена СергеевнаEniseevaElena S.

Cand.Med.Sci., associated professor, 

eniseeva-irk@yandex.ruИркутский государственный медицинский университет Иркутская государственная медицинская Академия последипломного образованияРоссияIrkutsk State Medical Academy of Postgraduate Education – Branch of Russian Medical Academy of Continuing Professional Education, Irkutsk State Medical UniversityRussian Federation202210122022111123Copyright © Eniseeva E.С., 20222022Енисеева Е.С.Eniseeva E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bmjour.ru/jour/article/view/22

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients.

Первичный альдостеронизм характеризуется автономной гиперсекрецией альдостерона, не связанной с акти-вацией ренин-ангиотензиновой системы. Активация минералокортикоидных рецепторов приводит к гипер-тонии, гипокалиемии и увеличивает риск сердечно-сосудистых заболеваний и заболеваний почек, а также смерти. Современные данные свидетельствуют о том, что распространённость первичного альдостеронизма намного выше, чем считалось ранее, и что более лёгкие формы ренин-независимой секреции альдостерона не выявляются. В обзоре рассматриваются особенности проведения скрининга, причины низкой выявляе-мости заболевания, группы больных с высокой вероятностью первичного альдостеронизма, методические подходы к оценке результатов скрининга. Обращается внимание на необходимость генетического исследо-вания у пациентов молодого возраста с семейным анамнезом первичного альдостеронизма. Обсуждаются различные методы исследования ренина и альдостерона, влияние выбора метода на оценку альдостерон-ренинового соотношения, причины ошибочной интерпретации результатов. Рассматриваются показания к проведению подтверждающих тестов и оценка их результатов. Обосновывается необходимость выявления одно- или двустороннего поражения надпочечников для определения выбора метода лечения. Сравниваются возможности компьютерной томографии и сравнительного селективного забора крови из надпочечниковых вен для определения одностороннего поражения. Подчёркивается важность своевременной диагностики первичного альдостеронизма и его целенаправленного лечения для снижения риска сердечно-сосудистых осложнений, связанных с гиперсекрецией альдостерона.

первичный альдостеронизмартериальная гипертонияальдостерон-рениновое соотношениеальдостерон-продуцирующая аденомадвусторонняя гиперплазия надпочечниковсравнительный селективный забор кровиprimary aldosteronismarterial hypertensionaldosterone-renin ratioaldosterone-producing adenomabilateral adrenal hyperplasiaadrenal venous sampling

Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin II. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the hypertension, hypokalemia, and it also increases the risk for cardiovascular and kidney disease, as well as death. Current evidence suggests that the prevalence of primary aldosteronism is much greater than previously recognized and milder forms of renin-independent aldosterone secretion may be common. These forms may be missed. This review focused screening in those at increased risk of primary aldosteronism. An approach to evaluating screening results was presented. Family aldosteronism should be considered in young hypertensive patients with a family history of primary aldosteronism. Genetic testing is appropriate in these patients. Careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance are discussed. Confirmatory tests and evaluation of their results are considered. The optimal approach to distinguish unilateral from bilateral primary aldosteronism is by adrenal vein sampling that is the only reliable method to select patients for surgery. More effective strategy to diagnose PA should lead to early detection of PA and could decrease the cardiovascular complications of the patients

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The authors declare that there are no conflicts of interest present.