Aldosteronismo primário
Summary
Definition
History and exam
Key diagnostic factors
- hipertensão
- presença de fatores de risco
Other diagnostic factors
- 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
Risk factors
- história familiar de AP
- história familiar de início precoce de hipertensão e/ou AVC
Diagnostic tests
1st tests to order
- potássio plasmático
- relação aldosterona/renina
Tests to consider
- 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
Emerging tests
- PET-CT com ¹¹ C-metomidato
Treatment algorithm
aldosteronismo primário (AP) unilateral
AP bilateral (excluindo hiperaldosteronismo familiar tipo I)
hiperaldosteronismo familiar tipo I
Contributors
Authors
Michael Stowasser, MBBS, FRACP, PhD
Professor
Endocrine Hypertension Research Centre
University of Queensland Frazer Institute
Greenslopes and Princess Alexandra Hospitals
Brisbane
Queensland
Australia
Disclosures
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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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