Zusammenfassung
Der primäre Hyperaldosteronismus (PHA) ist mit einer Prävalenz von 8–10% aller Hypertoniker die häufigste sekundäre Hypertonieursache. In Deutschland sind potenziell zwischen 2 und 2,5 Mio. Menschen durch einen PHA betroffen. Eine Screeninguntersuchung sollte morgens mit der Aldosteron-Renin-Ratio unter Berücksichtigung der Medikation erfolgen. Bei einer auffälligen Ratio muss ein Bestätigungstest zur Diagnosesicherung durchgeführt werden. Zur weiteren Abklärung des Subtyps des PHA erfolgt eine CT- oder MRT-Untersuchung der Nebennieren. Häufig empfiehlt sich eine seitengetrennte Nebennierenkatheterisierung zur Feststellung einer ein- oder beidseitigen Aldosteronübersekretion. Liegt ein aldosteronproduzierendes Adenom vor, besteht die Behandlung der Wahl in der laparoskopischen einseitigen Adrenalektomie. Bei der häufigeren Form des PHA, der bilateralen Nebennierenhyperplasie, ist die medikamentöse Therapie mit Mineralokortikoidantagonisten die Therapie der ersten Wahl (12,5–100 mg/Tag Spironolacton). Die Einstellung der medikamentösen Therapie sollte unter Elektrolyt- und Kreatininkontrollen erfolgen.
Abstract
The primary hyperaldosteronism (PHA) is the most prevalent form (8–10%) of secondary causes of hypertension among hypertensive subjects. This will result in 2 to 2.5 million people suffering from PHA in Germany. Screening for PHA should be performed by measuring the aldosterone-renin ratio in the morning. The current antihypertensive medication should be taken into account. A suspicious ratio must lead to a confirmatory test to validate the diagnosis of PHA. For further PHA subtype investigation adrenal imaging is performed using CT or MRI. Adrenal venous sampling is often required to definitively confirm uni- or bilateral aldosterone hypersecretion. The aldosterone-producing adenoma (Conn’s syndrome) is primarily cured by endoscopical unilateral adrenalectomy. Bilateral hyperplasia, which is found in two-thirds of primary hyperaldosteronism, is treated primarily by a mineralocorticoid receptor antagonist (12.5–100 mg/day spironolactone). The start of medication should be closely monitored by serum electrolyte and creatinine controls.
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Born-Frontsberg, E., Quinkler, M. Conn-Syndrom. Internist 50, 17–26 (2009). https://doi.org/10.1007/s00108-008-2195-8
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DOI: https://doi.org/10.1007/s00108-008-2195-8