Альманах клинической медицины. 2021; 49: 335-341
Диагностика и лечение альдостерон-продуцирующей аденомы у молодого пациента: клиническое наблюдение
https://doi.org/10.18786/2072-0505-2021-49-039Аннотация
Распространенность первичного гиперальдостеронизма (ПГА) среди лиц с эссенциальной артериальной гипертензией составляет около 5–10%. Приведен клинический пример 32-летнего пациента, который несмотря на типичную клиническую картину ПГА наблюдался в первичном звене по поводу миалгии и резистентной к терапии артериальной гипертензии. Обсуждены клинические и лабораторные показатели пациента с диагностированной односторонней альдостеромой и эффективность проведенного лечения. Общепринятый алгоритм диагностики ПГА при выявлении односторонней альдостерон-продуцирующей аденомы у лиц молодого возраста не предполагает проведения сравнительного селективного забора крови из надпочечниковых вен. Это ускоряет этап дифференциальной диагностики и способствует принятию решения о хирургическом лечении. Данный упрощенный алгоритм диагностики был успешно применен у этого пациента. Обоснованное оперативное вмешательство привело к излечению больного. Знакомство врачей разных специальностей с актуальной информацией о ПГА и внедрение в широкую клиническую практику скрининговых методов диагностики, в первую очередь исследования альдостерон-ренинового соотношения, будут способствовать максимально раннему выявлению заболевания и предотвращению развития угрожающих жизни сердечно-сосудистых осложнений.
Список литературы
1. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8): 1243–1248. doi: 10.1016/j.jacc.2005.01.015.
2. Stowasser M, Sharman J, Leano R, Gordon RD, Ward G, Cowley D, Marwick TH. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol Metab. 2005;90(9): 5070–5076. doi: 10.1210/jc.2005-0681.
3. Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. 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.
4. Xu Z, Yang J, Hu J, Song Y, He W, Luo T, Cheng Q, Ma L, Luo R, Fuller PJ, Cai J, Li Q, Yang S; Chongqing Primary Aldosteronism Study (CONPASS) Group. Primary aldosteronism in patients in China with recently detected hypertension. J Am Coll Cardiol. 2020;75(16): 1913–1922. doi: 10.1016/j.jacc.2020.02.052.
5. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, Gabetti L, Mengozzi G, Williams TA, Rabbia F, Veglio F, Mulatero P. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69(14): 1811–1820. doi: 10.1016/j.jacc.2017.01.052.
6. Hannemann A, Bidlingmaier M, Friedrich N, Manolopoulou J, Spyroglou A, Völzke H, Beuschlein F, Seissler J, Rettig R, Felix SB, Biffar R, Döring A, Meisinger C, Peters A, Wichmann HE, Nauck M, Wallaschofski H, Reincke M. Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies. Eur J Endocrinol. 2012;167(1): 7–15. doi: 10.1530/EJE-11-1013.
7. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5): 1889–1916. doi: 10.1210/jc.2015-4061.
8. Schirpenbach C, Reincke M. Primary aldosteronism: current knowledge and controversies in Conn's syndrome. Nat Clin Pract Endocrinol Metab. 2007;3(3): 220–227. doi: 10.1038/ncpendmet0430.
9. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF Jr. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89(3): 1045–1050. doi: 10.1210/jc.2003-031337.
10. Мельниченко ГА, Платонова НМ, Бельцевич ДГ, Юкина МЮ, Молашенко НВ, Трошина ЕА. Первичный гиперальдостеронизм: диагностика и лечение. Новый взгляд на проблему. По материалам Проекта клинических рекомендаций Российской ассоциации эндокринологов по диагностике и лечению первичного гиперальдостеронизма. Consilium Medicum. 2017;19(4): 75–85.
11. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study Investigators. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11): 2293–2300. doi: 10.1016/j.jacc.2006.07.059.
12. Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M, Rossi GP; PAPY Study Investigators. Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study. J Am Heart Assoc. 2017;6(5):e005574. doi: 10.1161/JAHA.117.005574.
13. Кобалава ЖД, Конради АО, Недогода СВ, Шляхто ЕВ, Арутюнов ГП, Баранова ЕИ, Барбараш ОЛ, Бойцов СА, Вавилова ТВ, Виллевальде СВ, Галявич АС, Глезер МГ, Гринева ЕН, Гринштейн ЮИ, Драпкина ОМ, Жернакова ЮВ, Звартау НЭ, Кисляк ОА, Козиолова НА, Космачева ЕД, Котовская ЮВ, Либис РА, Лопатин ЮМ, Небиеридзе ДВ, Недошивин АО, Остроумова ОД, Ощепкова ЕВ, Ратова ЛГ, Скибицкий ВВ, Ткачева ОН, Чазова ИЕ, Чесникова АИ, Чумакова ГА, Шальнова СА, Шестакова МВ, Якушин СС, Янишевский СН. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3): 3786. doi: 10.15829/1560-4071-2020-3-3786.
14. Lee FT, Elaraj D. Evaluation and management of primary hyperaldosteronism. Surg Clin North Am. 2019;99(4): 731–745. doi: 10.1016/j.suc.2019.04.010.
15. Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019;285(2): 126–148. doi: 10.1111/joim.12831.
16. Küpers EM, Amar L, Raynaud A, Plouin PF, Steichen O. A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab. 2012;97(10): 3530–3537. doi: 10.1210/jc.2012-1917.
17. Dick SM, Queiroz M, Bernardi BL, Dall'Agnol A, Brondani LA, Silveiro SP. Update in diagnosis and management of primary aldosteronism. Clin Chem Lab Med. 2018;56(3): 360–372. doi: 10.1515/cclm-2017-0217.
Almanac of Clinical Medicine. 2021; 49: 335-341
Diagnosis and treatment of aldosterone-producing adenoma in a young patient: a clinical case
https://doi.org/10.18786/2072-0505-2021-49-039Abstract
The prevalence of primary hyperaldosteronism (PHA) among individuals with essential arterial hypertension is about 5 to 10%. We present a clinical case of a 32 year old male patient, who despite the full clinical picture of PHA, was managed in primary care setting with the diagnosis of myalgia and treatment-resistant arterial hypertension. The article discusses clinical and laboratory parameters of the patient with the diagnosis of unilateral aldosteroma and the efficacy of its treatment. The generally accepted algorithm of PHA diagnosis with unilateral aldosterone-producing adenoma in young patients does not involve comparative selective blood sampling from adrenal veins. This accelerates the differential diagnosis and facilitates the decision to undertake surgery. This simplified diagnostic algorithm was successfully applied in the patient. Reasonable surgical intervention has led to the recovery of the patient. Awareness of various medical specialties of the up-to-date information on PHA and wide implementation of its screening into clinical practice, first of all, assessment of aldosterone-renin ratio, would allow for detection of the disease as early as possible and prevention of the development of life-threatening cardiovascular complications.
References
1. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8): 1243–1248. doi: 10.1016/j.jacc.2005.01.015.
2. Stowasser M, Sharman J, Leano R, Gordon RD, Ward G, Cowley D, Marwick TH. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol Metab. 2005;90(9): 5070–5076. doi: 10.1210/jc.2005-0681.
3. Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. 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.
4. Xu Z, Yang J, Hu J, Song Y, He W, Luo T, Cheng Q, Ma L, Luo R, Fuller PJ, Cai J, Li Q, Yang S; Chongqing Primary Aldosteronism Study (CONPASS) Group. Primary aldosteronism in patients in China with recently detected hypertension. J Am Coll Cardiol. 2020;75(16): 1913–1922. doi: 10.1016/j.jacc.2020.02.052.
5. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, Gabetti L, Mengozzi G, Williams TA, Rabbia F, Veglio F, Mulatero P. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69(14): 1811–1820. doi: 10.1016/j.jacc.2017.01.052.
6. Hannemann A, Bidlingmaier M, Friedrich N, Manolopoulou J, Spyroglou A, Völzke H, Beuschlein F, Seissler J, Rettig R, Felix SB, Biffar R, Döring A, Meisinger C, Peters A, Wichmann HE, Nauck M, Wallaschofski H, Reincke M. Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies. Eur J Endocrinol. 2012;167(1): 7–15. doi: 10.1530/EJE-11-1013.
7. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5): 1889–1916. doi: 10.1210/jc.2015-4061.
8. Schirpenbach C, Reincke M. Primary aldosteronism: current knowledge and controversies in Conn's syndrome. Nat Clin Pract Endocrinol Metab. 2007;3(3): 220–227. doi: 10.1038/ncpendmet0430.
9. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF Jr. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89(3): 1045–1050. doi: 10.1210/jc.2003-031337.
10. Mel'nichenko GA, Platonova NM, Bel'tsevich DG, Yukina MYu, Molashenko NV, Troshina EA. Pervichnyi giperal'dosteronizm: diagnostika i lechenie. Novyi vzglyad na problemu. Po materialam Proekta klinicheskikh rekomendatsii Rossiiskoi assotsiatsii endokrinologov po diagnostike i lecheniyu pervichnogo giperal'dosteronizma. Consilium Medicum. 2017;19(4): 75–85.
11. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study Investigators. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11): 2293–2300. doi: 10.1016/j.jacc.2006.07.059.
12. Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M, Rossi GP; PAPY Study Investigators. Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study. J Am Heart Assoc. 2017;6(5):e005574. doi: 10.1161/JAHA.117.005574.
13. Kobalava ZhD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, Barbarash OL, Boitsov SA, Vavilova TV, Villeval'de SV, Galyavich AS, Glezer MG, Grineva EN, Grinshtein YuI, Drapkina OM, Zhernakova YuV, Zvartau NE, Kislyak OA, Koziolova NA, Kosmacheva ED, Kotovskaya YuV, Libis RA, Lopatin YuM, Nebieridze DV, Nedoshivin AO, Ostroumova OD, Oshchepkova EV, Ratova LG, Skibitskii VV, Tkacheva ON, Chazova IE, Chesnikova AI, Chumakova GA, Shal'nova SA, Shestakova MV, Yakushin SS, Yanishevskii SN. Arterial'naya gipertenziya u vzroslykh. Klinicheskie rekomendatsii 2020. Rossiiskii kardiologicheskii zhurnal. 2020;25(3): 3786. doi: 10.15829/1560-4071-2020-3-3786.
14. Lee FT, Elaraj D. Evaluation and management of primary hyperaldosteronism. Surg Clin North Am. 2019;99(4): 731–745. doi: 10.1016/j.suc.2019.04.010.
15. Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019;285(2): 126–148. doi: 10.1111/joim.12831.
16. Küpers EM, Amar L, Raynaud A, Plouin PF, Steichen O. A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab. 2012;97(10): 3530–3537. doi: 10.1210/jc.2012-1917.
17. Dick SM, Queiroz M, Bernardi BL, Dall'Agnol A, Brondani LA, Silveiro SP. Update in diagnosis and management of primary aldosteronism. Clin Chem Lab Med. 2018;56(3): 360–372. doi: 10.1515/cclm-2017-0217.
