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Complicanze cardiometaboliche e renali nell’iperaldosteronismo primario

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Riassunto

L’iperaldosteronismo primario è la causa più comune di ipertensione arteriosa secondaria, interessando il 10% circa dei pazienti ipertesi. La terapia farmacologica rappresenta il trattamento di prima scelta per le forme idiopatiche, da iperplasia surrenalica bilaterale, mentre la surrenectomia risulta essere la terapia di scelta per i pazienti affetti da adenoma surrenalico secernente aldosterone (APA). Oltre al rialzo dei valori pressori e all’ipokaliemia, qualora presente, l’iperaldosteronismo primario è caratterizzato dallo sviluppo di complicanze cardiovascolari, renali e metaboliche. Da una recente rivisitazione della nostra esperienza clinica è emerso che l’asportazione chirurgica dell’adenoma determina la normalizzazione dell’asse renina-angiotensina-aldosterone e della kaliemia, migliora i valori pressori in tutti i pazienti e consente la risoluzione completa dell’ipertensione in circa la metà dei casi. La surrenectomia monolaterale, inoltre, rappresenta il miglior trattamento per la regressione delle complicanze cardiovascolari e metaboliche nei pazienti con APA. D’altra parte, il trattamento medico con antagonisti recettoriali dei mineralcorticoidi migliora il controllo pressorio e sembra prevenire la progressione della sindrome cardio-metabolica nei pazienti con iperplasia bilaterale.

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Authors and Affiliations

  1. Clinica di Endocrinologia, Università Politecnica delle Marche, Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italia

    Gilberta Giacchetti, Vanessa Ronconi, Lara Giovannini, Letizia Ceccoli, Valentina di Tizio, Federica Turchi &  Marco Boscaro

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  1. Gilberta Giacchetti
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  2. Vanessa Ronconi
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  3. Lara Giovannini
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  4. Letizia Ceccoli
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  5. Valentina di Tizio
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  6. Federica Turchi
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  7. Marco Boscaro
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Correspondence to Marco Boscaro.

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Giacchetti, G., Ronconi, V., Giovannini, L. et al. Complicanze cardiometaboliche e renali nell’iperaldosteronismo primario. L’Endocrinologo 12, 111–116 (2011). https://doi.org/10.1007/BF03344805

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