Der Internist

, Volume 47, Issue 9, pp 953–959 | Cite as

Moderne pharmakologische Aspekte der Therapie des Aldosteronismus

Arzneimitteltherapie

Zusammenfassung

Die Prävalenz des primären Hyperaldosteronismus liegt bei 5–10% aller Hypertoniker und damit deutlich höher als bisher angenommen. Besonders Patienten mit therapieresistenter Hypertonie haben mit bis zu 30% eine hohe Wahrscheinlichkeit an einem primären Hyperaldosteronismus zu leiden. In Deutschland sind nach aktuellen Schätzungen potenziell zwischen 1,5 und 2,5 Mio. Menschen von einem primären Hyperaldosteronismus betroffen. Damit ist neben der Diagnostik auch die Therapie des Hyperaldosteronismus von zunehmender Bedeutung. Liegt ein aldosteronproduzierendes Adenom vor, besteht die Behandlung der Wahl in der endoskopischen Adrenalektomie. Bei der häufigeren bilateralen Nebennierenhyperplasie ist die medikamentöse Therapie mit Mineralokortikoidantagonisten Therapie der ersten Wahl: 12,5–50 mg/Tag Spironolakton (alternativ bei Nebenwirkungen 50–100 mg/Tag Eplerenon). Bei nicht ausreichender Therapie werden andere kaliumsparende Diuretika, Kalziumantagonisten, ACE-Hemmer oder Angiotensin-II-Antagonisten hinzugenommen. Die Einstellung der medikamentösen Therapie sollte unter Elektrolyt- und Kreatininkontrollen erfolgen.

Schlüsselwörter

Hypertonus Hyperaldosteronismus Spironolakton Conn-Syndrom Eplerenon 

Modern pharmacological aspects of hyperaldosteronism therapy

Abstract

The prevalence of primary hyperaldosteronism is 5–10% of all hypertensive patients, and clearly above the estimated prevalence in the past. In nearly 30% of patients with therapy resistant hypertension, primary hyperaldosteronism is detected if they are investigated thoroughly. This will result in 1.5 to 2.5 million people in Germany suffering from primary hyperaldosteronism. Besides efficient diagnostic procedures, an effective treatment is of increasing importance. The aldosterone-producing adenoma (Conn’s syndrome) is primarily cured by operation, in most cases performed endoscopically. Bilateral hyperplasia, which is found in two-thirds of primary hyperaldosteronism, is treated primarily by mineralocorticoid receptor antagonist: 12.5–50 mg/day spironolactone (in case of anti-androgenic side-effects alternatively by 50–100 mg/day eplerenone). If the blood pressure can not be lowered by this first-line treatment, an additional treatment with potassium-sparing diuretics, calcium-antagonists, ACE-inhibitors or angiotensin-2-antagonists is necessary. The start of medication should be closely monitored by serum electrolyte and creatinine controls.

Keywords

Hypertension Hyperaldosteronism Spironolactone Conn’s syndrome Eplerenone 
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Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Klinische Endokrinologie, Innere Medizin mit Schwerpunkt Gastroenterologie, Hepatologie und EndokrinologieCampus Mitte, Charité UniversitätsmedizinBerlin
  2. 2.Medizinische Klinik-InnenstadtKlinikum der Maximilian-Ludwig-Universität München

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