Mineralocorticoid Excess and Hypertension: Review

Yıl 2009, Cilt: 3 Sayı: 2, 135 - 144, 26.07.2009

Reyhan Ersoy

Öz

Conditions resulting from mineralocorticoid excess come either from excess mineralocorticoid or increased mineralocorticoid activity. Secretion of mineralocorticoid hormones is regulated by renin-angiotensin-aldosterone axis and potassium. Hyperaldosteronizm plays a role in 0.5-2% etiology of all hypertensive cases. In most cases nonspecific symptoms of hypertension are seen. Hypokalemia related neuromuscular signs like muscle weakness, malaise, paresthesia are associated to these symptoms. Spontaneous hypokalemia and hypertension support the mineralocorticoid excess. The evaluation of a patient whom hyperaldosteronism is suggested has several distinct stages. The first step entails confirmation that hyperaldosteronism is present or it is not present. The next step involves tests to differentiate primary from secondary causes of hyperaldosteronism and tests to determine subtypes of primer hyperaldosteronism. This paper will review the conditions of mineralocorticoid excess, diagnostic tests and therapy modalities.

Anahtar Kelimeler

Mineralocorticoid excess, hypertension, hypokalemia

Mineralokortikoid Fazlalığı ve Hipertansiyon

Öz

Mineralokortikoid fazlalığı ile seyreden durumlar, otonom olarak mineralokortikoid aşırı şahmına ya da mineralokortikoid aktivite artışına bağlı gelişir. Mineralokortikoidlerin ana regülas-yon sistemi renin- angiotensin- aldosteron aksı ve potasyumdur. Hipertansif olguların %0.5-2’de eti-yolojide hiperaldosteronizm rol oynar. Pek çok hastada nonspesifik semptomlarla karakterize hipertansiyon vardır. Buna hipokalemiye bağlı halsizlik, kas güçsüzlüğü ve parestezi gibi nöromüs-küler belirtiler eşlik edebilir. Spontan hipokalemi ve hipertansiyon mineralocorticoid fazlalığını destekler. Hiperaldosteronizmli hastanın değerlendirilmesi birçok farklı aşamaları gerektirir. Öncelikle hiperaldosteronizmin doğrulanması gereklidir. Daha sonraki evre primer ve sekonder hipe-raldosteronizmin ayırıcı tanısı için yapılan testleri ve primer aldosteronizmin alt tiplerinin belirlenmesi için yapılan testleri kapsar. Bu makalede mineralocorticoid artışına neden olan durumlar, tanısal testler ve tedavi yaklaşımları gözden geçirilecektir.

Dr. Ayten OGUZ, Dr. Reyhan ERSOY

Anahtar Kelimeler

Mineralokortikoid fazlalığı, hipertansiyon, hipokalemi

Kaynakça

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