Сложности диагностики первичного гиперальдостеронизма

Первичный гиперальдостеронизм (ПГА) характеризуется избыточной секрецией альдостерона, неподконтрольной регуляции ренин-ангиотензин-альдостероновой системой. Избыточная секреция альдостерона приводит к развитию гипертензии, гипокалиемии и специфическому повреждению сердечно-сосудистой системы и почек. На данный момент ПГА считается наиболее частой причиной вторичной артериальной гипертензии, хотя ранее его рраспространённость была недооценена. Наиболее частыми причинами ПГА являются аденома и гиперплазия надпочечников. Важность своевременной диагностики ПГА заключается не только в достижении стабильного контроля артериального давления, но и предотвращения негативных эффектов прямого влияния избытка альдостерона на сердечно-сосудистую систему и почки. Отношение альдостерона к ренину длительно являлось выборочным тестом для скрининга ПГА, однако сложность его интерпретации, отсутствие четких разграничений и разнообразие единиц измерения затрудняют его оценку, что заставило некоторых исследователей искать новые способы скрининга ПГА. Дифференциальная диагностика между идиопатической гиперплазией надпочечников (ИГН) и альдостеронпродуцирующей аденомой (АПА) имеет важное значение для выбора соответствующего лечения. Следовательно, для выявления подтипа ПГА необходимо проведение визуализирующих исследований, таких как компьютерная томография, и катетеризация надпочечниковых вен с исследованием концентрации альдостерона. Подтип ПГА определяет оптимальное лечение — хирургическое при АПА или фармакологическое при ИГН, с использованием таких препаратов, как антагонисты минералокортикоидных рецепторов.

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