Preview

Rational Pharmacotherapy in Cardiology

Advanced search

In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism

https://doi.org/10.20996/1819-6446-2020-08-19

Full Text:

Abstract

Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.

About the Authors

O. V. Tsygankova
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science; Novosibirsk State Medical University
Russian Federation

Oksana V. Tsygankova – MD, PhD, Professor, Chair of Emergency Therapy with Endocrinology and Occupational Pathology, Novosibirsk State Medical University; Senior Researcher, Laboratory for Clinical, Biochemical and Hormonal Research of Therapeutic Diseases, Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science

B. Bogatkova ul. 175/1, Novosibirsk, 630089, 

Krasny prospect 52, Novosibirsk, 630091



T. I. Batluk
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science
Russian Federation

Tatiana I. Batluk – Postgraduate Student

B. Bogatkova ul. 175/1, Novosibirsk, 630089



L. D. Latyntseva
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science
Russian Federation

Lyudmila D. Latyntseva – MD, PhD, Head of Therapeutic Department, Senior Researcher, Laboratory of Emergency Cardiology

B. Bogatkova ul. 175/1, Novosibirsk, 630089



E. V. Akhmerova
City Clinical Polyclinic №16
Russian Federation

Elena V. Akhmerova – MD, PhD, Head of City Endocrinology Center

Parhomenko pervyj per. 32 Novosibirsk, 630078



N. M. Akhmedzhanov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Nadir M. Akhmedzhanov – MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention

Petroverigsky per. 10, Moscow, 101990



References

1. Williams B., Mancia G., Spiering W., et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy339.

2. Funder J.W., Carey R.M., Mantero F., et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916. DOI:10.1210/jc.2015-4061.

3. Stowasser M. Update in primary aldosteronism. J Clin Endocrinol Metab. 2015;100(1):1-10. DOI:10.1210/jc.2014-3663.

4. Mulatero P, Monticone S, Bertello C, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab. 2013;98(12):4826-33. DOI:10.1210/jc.2013-2805.

5. Nadeeva R.A., Kamasheva G.R., Yagfarova R.R. Primary hyperaldoseronism in the structure of arterial hypertension: actuality of problem. The Bulletin of Contemporary Clinical Medicine. 2015;8(6):98- 102 (In Russ.) DOI:10.20969/vskm.2015.8(6).98-102.

6. Young W.F. Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019;285(2):126-48. DOI:10.1111/joim.12831.

7. Milliez P., Girerd X., Plouin P.F., et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243-8. DOI:10.1016/j.jacc.2005.01.015.

8. Monticone S., D'Ascenzo F., Moretti C., et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6(1):41-50. DOI:10.1016/S2213-8587(17)30319-4.

9. Prada E.T.A., Burrello J., Reincke M., Williams T.A. Old and New Concepts in the Molecular Pathogenesis of Primary Aldosteronism. Hypertension. 2017;70:875-81. DOI:10.1161/HYPERTENSIONAHA.117.10111.

10. Chikladze N.M., Favorova O.O., Chazova I.E. Family hyperaldosteronism type I: a clinical case and review of literature. Ter Arkhiv. 2018;9:115-22 (In Russ.) DOI:10.26442/terarkh2018909115-122.

11. Omata K., Satoh F., Morimoto R., et al. Cellular and Genetic Causes of Idiopathic Hyperaldosteronism. Hypertension. 2018;72(4):874-80. DOI:10.1161/HYPERTENSIONAHA.118.11086.

12. Liao C.W., Lin Y.T., Wu X.M., et al.; TAIPAI Study Group. The relation among aldosterone, galectin3, and myocardial fibrosis: a prospective clinical pilot follow-up study. J Investig Med. 2016;64(6):1109-13. DOI:10.1136/jim-2015-000014.

13. Lee H.H., Hung C.S., Wu X.M., et al.; Taipai Study Group. Myocardial ultrasound tissue characterization of patients with primary aldosteronism. Ultrasound Med Biol. 2013;39(1):54-61. DOI:10.1016/j.ultrasmedbio.2012.08.023.

14. Grytaas M.A., Sellevåg K., Thordarson H.B., et al. Cardiac magnetic resonance imaging of myocardial mass and fibrosis in primary aldosteronism. Endocr Connect. 2018;7(3):413-24. DOI:10.1530/EC18-0039.

15. Tsygankova O.V., Kalinina E..M, Latyntseva L.D., Voevoda M.I. Successful correction of refractory arterial hypertension and morbid obesity in patient with severe obstructive apnea syndrome. Russian Journal of Cardiology. 2018;(5):74-80 (In Russ.) DOI:10.15829/1560-4071-2018-5-74-80.

16. Dudenbostel T., Calhoun D.A. Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens. 2011;26(5):281-7. DOI:10.1038/jhh.2011.4.

17. Calhoun D.A., Nishizaka M.K., Zaman M.A., Harding S.M. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest. 2004;125(1):112-7. DOI:10.1378/chest.125.1.112.

18. Gonzaga C.C., Gaddam K.K., Ahmed M.I., et al. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med. 2010;6(4):363-8. DOI:10.1097/01.hjh.0000379812.66839.11.

19. Di Murro A., Petramala L., Cotesta D., et al. Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism. Journal of the Renin-Angiotensin-Aldosterone System. 2010;11(3):165-72. DOI:10.1177/1470320310366581.

20. Akhadov S.V., Ruzbanova G.R., Molchanovа G.S. Evolution stages of low renin hypertension. Rational Pharmacotherapy in Cardiology. 2010;6(1):68-72 (In Russ.) DOI:10.20996/1819-6446-2010-6-1-68-72.

21. Hanon O., Boully C., Caillard L., et al. Treatment of hypertensive patients with diabetes and microalbuminuria with combination indapamide SR/amlodipine: retrospective analysis of NESTOR. Am J Hypertens. 2015;28:1064-71. DOI:10.1093/ajh/hpu297.

22. Markel A.L. Genetics and pathophysiology of low-renin arterial hypertension. Vavilov Journal of Genetics and Breeding. 2018;22(8):1000-8 (In Russ.) DOI:10.18699/vj18.443.

23. Melnichenko G.A., Platonova N.M., Beltsevich D.G., et al. Primary hyperaldosteronism: diagnosis and treatment. A new look at the problem. According to the materials of the Russian Association of Endocrinologists clinical guidelines for primary hyperaldosteronism diagnosis and treatment. Consilium Medicum. 2017;19(4):75-85 (In Russ.) DOI:10.26442/2075-1753_19.4.75-85.

24. Williams T.A., Reincke M. Management of endocrine disease: Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited. Eur J Endocrinol. 2018;179(1):R19- R29. DOI:10.1530/EJE-17-0990.

25. Mulatero P., Stowasser M., Loh K.C., et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. Journal of Clinical Endocrinology and Metabolism. 2004;89(3):1045-50. DOI:10.1210/jc.2003-031337.

26. Dedov I.I., Melnichenko G.A., eds. Incidentaloma nadpochechnikov (diagnostika i differencialnaya diagnostika). Metodicheskie rekomendacii dlya vrachej pervichnogo zvena. M.: FGBU ENC; 2015 (In Russ.)

27. Young W.F., Stanson A.W., Thompson G.B., et al. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136(6):1227-35. DOI:10.1016/j.surg.2004.06.051.

28. Nwariaku F.E., Miller B.S., Auchus R., et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg. 2006;141(5):497-502. DOI:10.1001/archsurg.141.5.497.

29. Tsygankova O.V., Khudyakova A.D., Latyntseva L.D., Lozhkina N.G. Cardiovascular continuum: from risk factors to the systolyc heart failure (the clinical case). Atherosclerosis. 2017;13(4):42-6 (In Russ.) DOI:10.15372/ATER20170407.


For citation:


Tsygankova O.V., Batluk T.I., Latyntseva L.D., Akhmerova E.V., Akhmedzhanov N.M. In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism. Rational Pharmacotherapy in Cardiology. 2020;16(4):557-563. (In Russ.) https://doi.org/10.20996/1819-6446-2020-08-19

Views: 56


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)