Aldosteronism


In a medical environment, aldosteronism is usually divided into primary - Conn's syndrome and secondary.

Primary aldosteronism

Primary aldosteronism was first described by Conn, relatively recently, in 1955. This syndrome is caused most often by the hormonal-active adrenal adenoma of the adrenal cortex, which stimulates the body to produce an excessive( in dozens of times the norm) amount of aldosterone. As a result of this imbalance of hormones in patients, there is a violation of water-salt metabolism in the body. In most cases, this adenoma affects only one adrenal gland, very rarely both or one organ has multiple lesions. With Conn's syndrome, the following symptoms can occur:

  • increase in the level of sodium in the blood;

  • decrease in potassium in the body( below 3 mmol / l);

  • muscle weakness;

  • discomfort and pain in the muscles;

  • constant thirst;

  • increased frequency of urination and an increase in their number;

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  • hypertension( blood pressure constantly rises to 150/90, and even 180/100 mm Hg);

  • gross changes in kidney function;

  • persistent severe headache, mainly in the forehead;

  • frequent seizures;

  • constantly recurring sharp pains in the region of the heart;

  • often heart palpitations;

  • persistent shortness of breath;

  • frequent hypertensive crises;

  • cerebrovascular accident( in cases of advanced disease);

  • significant increase in aldosterone levels.

Even in the presence of several of the above symptoms it is not absolutely guaranteed that the patient will be diagnosed with aldosteronism. Symptoms such as severe hypertension, persistent weakness, severe thirst, frequent urination, high sodium levels and low potassium, and even an increase in the amount of aldosterone may also indicate other diseases requiring completely different treatment. These may include: glomerulonephritis, diabetes non-sugar etiology, hypertensive disease.

In very rare cases, primary aldosteronism can be caused by a malignant tumor of the adrenal gland, but such cases are rare( less than 1% of the total number of cases).

The diagnosis of primary aldosteronism is based on the typical clinical picture for this syndrome: long-term high blood pressure, very high sodium concentration, low potassium levels and the resulting damage to the muscles and kidneys, but with no edema in the patient.

To confirm the diagnosis, the patient, in a hospital, conducts studies aimed at identifying the impossibility of reducing the production of aldosterone at a long high salt level.

As a treatment for primary aldosteronism, a radical method is often used - surgical intervention. Depending on the extent of the lesion, either the neoplasm is removed, or part of the "occupied" organ, or the entire adrenal gland affected by aldosteronoma.

In more mild cases, in the early stages of the disease, long-term drug treatment with spironolactone or its analogues, suppressing aldosterone, and only in case of failure, surgical intervention is practiced. With any method of treatment, a diet is recommended, aimed at reducing the sodium content in the body and increasing the level of potassium due to food. In the case of prompt attention to the patient, glucocorticoid hormones are prescribed.

For patients with a confirmed diagnosis of primary aldosteronism, who turned to specialists for help on time, usually a very favorable prognosis for overcoming the disease.

Secondary aldosteronism was first described by various medical scientists in the 1950s. This disease is caused, as in the first case, by an increased level of production of the hormone aldosterone, but by healthy adrenals, which are not affected by anything.

This occurs usually when the composition of blood electrolytes changes or when the aldosterone is not completely destroyed by the liver.

The most common causes of secondary aldosteronism:

  • hypertension and renal hypertension, accompanied by acute renal ischemia;

  • heart failure;

  • nephrotic kidney syndrome, accompanied by permanent edema;

  • acute diffuse glomerulonephritis in edematous form;

  • Botkin's disease;

  • cirrhosis;

  • chronic hepatitis;

  • Decompensated diabetes( both sugar and non-sugar);

  • nephritis( with loss of sodium);

  • myocardial infarction;

  • pneumonia;

  • intake of diuretics, removing sodium, a fairly long period;

  • is a salt-free diet for several months.

Secondary aldosteronism is divided into edematic and non-edema forms. The presence of edema depends largely on the course of the underlying disease.

During treatment of secondary aldosteronism, more attention is paid to the treatment of the underlying disease, elimination of factors that increased the production of aldosterone. In the edematic form of the disease, in addition to standard diuretics, drugs that suppress aldosterone, as well as prednisolone, which helps normalize the protein composition of the blood and improve liver function are used.

For patients diagnosed with secondary aldosteronism, the positive outcome of treatment directly depends on the success of the fight against the underlying disease.

After carrying out competent and timely treatment, taking into account:

  • degree of neglect of aldosteronism;
  • localization of aldehsterone( in the case of Connes syndrome);
  • of the severity of concomitant and basic( in the case of secondary alsteronism) diseases.

The patient returns to normal, full-fledged life. Thus doctors mark normalization of work of all systems of an organism, caused by return of level of aldosterone to parameters of norm.