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Hochdruck und Nebenniere

Hypertension and the adrenal gland

Zusammenfassung

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.

Abstract

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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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). https://doi.org/10.1007/s11560-022-00584-9

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Schlüsselwörter

  • Primärer Hyperaldosteronismus
  • Hypertonie
  • Aldosteron
  • Renin
  • Mineralokortikoidrezeptorantagonisten

Keywords

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