Diagnostik und Therapie des Conn-Syndroms: neue Aspekte

Der primäre Hyperaldosteronismus ist die häufigste Ursache der endokrinen Hypertonie. Er ist im Vergleich zur essenziellen Hypertonie mit einer höheren Morbidität und Letalität verbunden. Die frühzeitige Identifizierung der betroffenen Patienten ist von entscheidender Bedeutung, da eine adäquate Therapie zu einer ausgezeichneten Langzeitprognose führt. In den letzten Jahren erschienen substanziell neue Beiträge zur Diagnostik und Therapie des Conn-Syndroms, die in diesem Beitrag dargestellt werden.

Abstract

Primary aldosteronism represents the most frequent cause of endocrine hypertension. It is associated with a higher morbidity and mortality compared to essential hypertension. Early identification of the affected patients is crucial, as the adequate therapy leads to an excellent long-term prognosis, especially after unilateral adrenalectomy. Diagnosis consists of three steps: diagnosis, confirmation test and subtype differentiation. The 2 most frequent causes of primary aldosteronism are aldosterone producing adenoma, which can be cured by surgery, and idiopathic bilateral adrenal hyperplasia, which is treated with mineralocorticoid receptor antagonists.

Screening by aldosterone-to-renin ratio is recommended in designed risk populations. As the aldosterone-to-renin ratio displays a limited sensitivity and specificity, confirmatory testing is recommended in most patients with positive screening test. Prediction scores allow to skip confirmatory testing under certain circumstances. Adrenal vein sampling still represents the gold standard in subtype differentiation of primary aldosteronism. Steroid profiling could possibly make dispensable adrenal vein sampling in patients with bilateral hyperplasia. Different studies investigate the potential of functional imaging for differential diagnosis of primary aldosteronism.

Schlüsselwörter

endokrine Hypertonie - Aldosteron - Renin - Nebennieren-Venen-Katheter - Adrenalektomie

Key words

endocrine hypertension - aldosterone - renin - adrenal vein sampling - adrenalectomy

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