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Hyperaldosteronismus und verstärkte Aktivität des Mineralokortikoidrezeptors

Hyperaldosteronism and increased activity of the mineralocorticoid receptor

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Der Nephrologe Aims and scope

Zusammenfassung

Aldosteron ist ein Nebennierenrindenhormon mit pleiotroper Wirkung. Es stimuliert den Mineralokortikoidrezeptor (MR), der an zahlreichen physiologischen und pathophysiologischen Prozessen beteiligt ist; eine verstärkte Aktivität zusammen mit einer inadäquat hohen Salzzufuhr führt zu Bluthochdruck und entzündlich fibrotischen Veränderungen im Gewebe. Darüber hinaus werden zahlreiche weitere Regelkreise beeinflusst, z. B. solche, die in die Regulation der Geweberegeneration oder der renalen Eiweißausscheidung eingebunden sind. Häufige Ursachen für die verstärkte Aktivierung des MR sind einseitige Nebennierenadenome und eine bilaterale Hyperplasie mit unkontrollierter Aldosteronsynthese. Therapieoptionen umfassen die operative Entfernung eines Tumors und die medikamentöse Blockade des MR. Zu den klinisch relevanten Perspektiven zählen die Entwicklung neuer, selektiver Antagonisten der MR-Aktivität mit verminderten Nebenwirkungen bzw. die erweiterte Indikation von MR-Blockern.

Abstract

Aldosterone is an adrenal hormone with pleitropic activity. It stimulates the mineralocorticoid receptor (MR), which modulates numerous physiological and pathophysiological processes. Increased receptor activity together with inappropriate salt intake leads to arterial hypertension as well as inflammatory and fibrotic tissue remodeling. In addition, numerous other pathways in tissue remodeling, including renal protein excretion, are affected. Common causes of increased MR activity are unilateral adrenal adenoma and bilateral hyperplasia producing an excess of aldosterone. Therapy for these conditions is unilateral adrenalectomy, if appropriate, or pharmacological MR blockade. Current studies to improve management of this condition focus on the development of new, more selective modulators of MR activity with fewer side effects and clinical studies to broaden the usage of MR blockers.

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Fiebeler, A., Quinkler, M. Hyperaldosteronismus und verstärkte Aktivität des Mineralokortikoidrezeptors. Nephrologe 6, 77–87 (2011). https://doi.org/10.1007/s11560-010-0494-2

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  • DOI: https://doi.org/10.1007/s11560-010-0494-2

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