Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- hipertensão
- presença de fatores de risco
Outros fatores diagnósticos
- idade entre 20 e 70 anos
- noctúria, poliúria
- letargia
- distúrbios de humor (irritabilidade, ansiedade e depressão)
- dificuldade de concentração
- parestesias, cãibras musculares
- fraqueza muscular
- palpitações
Fatores de risco
- história familiar de AP
- história familiar de início precoce de hipertensão e/ou AVC
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- potássio plasmático
- relação aldosterona/renina
Investigações a serem consideradas
- teste de carga oral de sal
- teste de infusão de soro fisiológico
- teste genético
- tomografia computadorizada (TC) da adrenal
- amostragem da veia adrenal
- ressonância nuclear magnética (RNM) adrenal
- teste de estimulação de postura
- teste de infusão de angiotensina II
- esteroides híbridos urinários de 24 horas (18-hidroxi e 18-oxocortisol)
- teste de supressão de dexametasona
Novos exames
- PET-CT com ¹¹ C-metomidato
Algoritmo de tratamento
aldosteronismo primário (AP) unilateral
AP bilateral (excluindo hiperaldosteronismo familiar tipo I)
hiperaldosteronismo familiar tipo I
Colaboradores
Autores
Michael Stowasser, MBBS, FRACP, PhD
Professor
Endocrine Hypertension Research Centre
University of Queensland Frazer Institute
Greenslopes and Princess Alexandra Hospitals
Brisbane
Queensland
Australia
Declarações
MS is an author of several references cited in this topic.
Acknowledgements
Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this topic.
Peer reviewers
Paolo Mulatero, MD
Department of Medicine and Experimental Oncology
Division of Medicine and Hypertension
San Giovanni Battista Hospital
Torino
Italy
Disclosures
PM declares that he has no competing interests.
Wail Malaty, MD
Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
Assistant Program Director
MAHEC Rural Family Medicine Residency
Hendersonville
NC
Disclosures
WM declares that he has no competing interests.
References
Key articles
Mulatero P, Sechi LA, Williams TA, et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020 Oct;38(10):1929-36. Abstract
Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92. Abstract
Funder JW, Carey RM, 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 May;101(5):1889-916.Full text Abstract
Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hipertensão essencial
- Hipocalemia induzida por tiazida em pacientes com hipertensão essencial
- Estenose da artéria renal
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021
More Guidelines
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