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Hochdruck und Nebenniere

Hypertension and the adrenal gland


Der primäre Hyperaldosteronismus (PHA) gilt als häufigste Form der sekundären Hypertonie und ist durch eine vermehrte, autonome Aldosteronproduktion der Nebennierenrinde gekennzeichnet. Der PHA ist mit einer deutlich erhöhten kardiovaskulären Morbidität und Mortalität assoziiert. Eine frühe Diagnose und eine spezifische Therapie sind daher von entscheidender Bedeutung. Der Diagnosealgorithmus gliedert sich in das Screening, einen Bestätigungstest sowie die Subtypdiagnostik. Ein niedriges Renin ist ein wichtiger Hinweis für einen PHA, das Aldosteron kann hingegen normal oder erhöht sein. Leitlinien empfehlen eine Adrenalektomie für geeignete Patienten mit gesichertem unilateralen PHA. Bei etwa 37 % der Patienten kommt es postoperativ zu einer kompletten klinischen Heilung. Für die medikamentöse Therapie sind Mineralokortikoidrezeptorantagonisten Mittel der Wahl.


Primary raldosteronism (PA) is the most common form of secondary hypertension and is caused by increased autonomic aldosterone production by the adrenal cortex. PA is associated with a significantly increased cardiovascular morbidity and mortality. An early diagnosis and specific treatment are therefore of crucial importance. The diagnostic algorithm consists of screening, a confirmatory test and subtype classification. Suppressed renin and normal or elevated aldosterone levels are diagnostic hallmarks of PA. The guidelines recommend adrenalectomy for eligible patients with confirmed unilateral PA. In about 37% of the patients adrenalectomy leads to a complete clinical cure. Mineralocorticoid receptor antagonists (MRAs) are recommended for pharmaceutical treatment.

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  1. Stowasser M, Gordon RD (2016) Primary aldosteronism: changing definitions and new concepts of physiology and pathophysiology both inside and outside the kidney. Physiol Rev 96:1327–1384.

    CAS  Article  PubMed  Google Scholar 

  2. Monticone S, Burrello J, Tizzani D et al (2017) Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 69(14):1811–1820.

    Article  PubMed  Google Scholar 

  3. Hattangady NG, Olala LO, Bollag WB, Rainey WE (2012) Acute and chronic regulation of aldosterone production. Mol Cell Endocrinol 350:151–162

    CAS  Article  Google Scholar 

  4. Funder JW (2017) Aldosterone and mineralocorticoid receptors—physiology and pathophysiology. Int J Mol Sci.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hall ME, Hall JE (2018) 5‑pathogenesis of hypertension. In: Bakris GL, Sorrentino MJ (Hrsg) Hypertension: a companion to Braunwald’s heart disease, 3. Aufl. Elsevier, S 33–51

    Chapter  Google Scholar 

  6. Hundemer GL, Curhan GC, Yozamp N et al (2018) Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 6:51–59.

    Article  PubMed  Google Scholar 

  7. Savard S, Amar L, Plouin P‑F, Steichen O (2013) Cardiovascular complications associated with primary aldosteronism. Hypertension 62:331–336.

    CAS  Article  PubMed  Google Scholar 

  8. Reincke M, Fischer E, Gerum S et al (2012) Epidemiology/population science observational study mortality in treated primary aldosteronism the German conn’s registry. Hypertension 60:618–624.

    CAS  Article  PubMed  Google Scholar 

  9. Hall JE, Granger JP, Smith MJ, Premen AJ (1984) Role of renal hemodynamics and arterial pressure in aldosterone „escape“. Hypertension 6:I183.

    CAS  Article  PubMed  Google Scholar 

  10. Ribstein J, Du Cailar G, Fesler P, Mimran A (2005) Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 16:1320–1325.

    Article  PubMed  Google Scholar 

  11. Hundemer GL, Curhan GC, Yozamp N et al (2018) Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension 72:658–666.

    CAS  Article  PubMed  Google Scholar 

  12. Rossi GP, Bernini G, Desideri G et al (2006) Renal damage in primary aldosteronism: results of the PAPY study. Hypertension 48:232–238.

    CAS  Article  PubMed  Google Scholar 

  13. Khurshid KA, Weaver ME (2005) Conn’s syndrome presenting as depression. Am J Psychiatry 162:1226.

    Article  PubMed  Google Scholar 

  14. Reincke M (2018) Anxiety, depression, and impaired quality of life in primary aldosteronism: why we shouldn’t ignore it! J Clin Endocrinol Metab 103:1–4

    Article  Google Scholar 

  15. Funder JW, Carey RM, Mantero F et al (2016) The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101:1889–1916.

    CAS  Article  PubMed  Google Scholar 

  16. Funder JW (2020) Primary Aldosteronism: the next decade. Hypertens 76:325–326

    CAS  Article  Google Scholar 

  17. Byrd BJ, Turcu AF, Auchus RJ (2018) Primary aldosteronism: practical approach to diagnosis and management. Circulation 138:823–835.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Brown JM, Siddiqui M, Calhoun DA et al (2020) The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med 173:10–20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Williams B, MacDonald TM, Morant SV et al (2018) Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY‑2 mechanisms substudies. Lancet Diabetes Endocrinol.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Citton M, Viel G, Rossi GP et al (2015) Outcome of surgical treatment of primary aldosteronism. Langenbecks Arch Surg 400:325–331.

    Article  PubMed  Google Scholar 

  21. Williams TA, Lenders JWM, Mulatero P et al (2017) Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 5:689–699.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rye P, Chin A, Pasieka J et al (2015) Unadjusted plasma renin activity as a „first-look“ test to decide upon further investigations for primary aldosteronism. J Clin Hypertens 17:541–546.

    CAS  Article  Google Scholar 

  23. Baudrand R, Vaidya A (2018) The low-renin hypertension phenotype: genetics and the role of the mineralocorticoid receptor. Int J Mol Sci.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Funder JW (2014) Sensitivity to aldosterone: plasma levels are not the full story. Hypertension 63:1168–1170

    CAS  Article  Google Scholar 

  25. Baudrand R, Guarda FJ, Fardella C et al (2017) Continuum of renin-independent aldosteronism in normotension. Hypertension 69:950–956.

    CAS  Article  PubMed  Google Scholar 

  26. Stowasser M, Ahmed AH, Pimenta E et al (2012) Factors affecting the aldosterone/renin ratio. Horm Metab Res 44:170–176

    CAS  Article  Google Scholar 

  27. Guo Z, Poglitsch M, Cowley D et al (2020) Effects of ramipril on the aldosterone/renin ratio and the aldosterone/angiotensin II ratio in patients with primary aldosteronism. Hypertension.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Song Y, Yang S, He W et al (2018) Confirmatory tests for the diagnosis of primary aldosteronism: a prospective diagnostic accuracy study. Hypertension 71:118–124.

    CAS  Article  PubMed  Google Scholar 

  29. Giacchetti G, Ronconi V, Lucarelli G et al (2006) Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol. Lippincott Williams & Wilkins

    Book  Google Scholar 

  30. Morera J, Reznik Y (2019) Management of endocrine disease: the role of confirmatory tests in the diagnosis of primary aldosteronism. Eur J Endocrinol 180:R45–R58

    CAS  Article  Google Scholar 

  31. Becker LS, Hinrichs MH, Werncke T et al (2021) Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C‑arm CT findings. Abdom Radiol 46:3471–3481.

    CAS  Article  Google Scholar 

  32. Williams B, Macdonald TM, Morant S et al (2015) Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 386:2059–2068.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Jeunemaitre X, Chatellier G, Kreft-Jais C et al (1987) Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol 60:820–825.

    CAS  Article  PubMed  Google Scholar 

  34. Parthasarathy HK, Ménard J, White WB et al (2011) A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens.

    Article  PubMed  Google Scholar 

  35. Gemeinsamer Bundesausschuss (2022) Erteilung von Aufträgen an die Expertengruppen Off-Label: Eplerenon bei primärem Hyperaldosteronismus, wenn eine Therapie mit Spironolacton nicht oder nicht mehr infrage kommt. Zugegriffen: 25. März 2022

  36. Huang W‑C, Chen Y‑Y, Lin Y‑H, Chueh JS (2021) Composite cardiovascular outcomes in patients with primary aldosteronism undergoing medical versus surgical treatment: a meta-analysis. Front Endocrinol.

    Article  Google Scholar 

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Correspondence to Christian Beger.

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C. Beger, H. Haller und F.P. Limbourg geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hermann Haller, Hannover

Joachim Hoyer, Marburg

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Beger, C., Haller, H. & Limbourg, F.P. Hochdruck und Nebenniere. Nephrologie 17, 233–238 (2022).

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  • Primärer Hyperaldosteronismus
  • Hypertonie
  • Aldosteron
  • Renin
  • Mineralokortikoidrezeptorantagonisten


  • Primary aldosteronism
  • Hypertension
  • Aldosterone
  • Renin
  • Mineralocorticoid receptor antagonists