Primary aldosteronism (PA) is a clinical syndrome caused by excessive secretion of aldosterone by the adrenal cortex, which is characterized by hypertension, hypokalemia and a series of symptoms caused by it. There are some common misunderstandings in the treatment of primary aldosteronism, which may affect the treatment effect and prognosis of patients. The following is a detailed discussion of the misunderstandings in the treatment of primary aldosteronism:
I. Misunderstanding
of Screening and Diagnosis
1. Screening objects are too limited
Myth: In the past, it was believed that only patients with hypertension and hypokalemia needed to be screened for aldosteronism.
Correction: In fact, the incidence of hypokalemia in patients with primary aldosteronism is not high, and some patients with primary aldosteronism may not have hypokalemia. Therefore, screening should be extended to all patients with persistent hypertension, refractory hypertension, and other manifestations of aldosteronism (such as adrenal incidentaloma, family history of early-onset hypertension, etc.).
2. Inaccurate
screening methods
Myth: The ratio of aldosterone to renin activity (ARR) was not used as the preferred screening index.
Correction: ARR is the most commonly used screening index for primary aldosteronism, with high sensitivity and specificity. Before screening, adequate preparations should be made, such as correcting blood potassium, maintaining normal sodium intake, and stopping drugs that affect ARR, to ensure the accuracy of screening results.
2. Misunderstanding
of treatment
1. Neglecting the importance
of surgical treatment
Misunderstanding: It is believed that all patients with primary aldosteronism can obtain good curative effect through drug treatment.
Correction: Surgical treatment is the first choice for patients with aldosteronoma and unilateral adrenal hyperplasia. Surgical removal of the lesion can significantly reduce aldosterone levels and improve symptoms of hypertension and hypokalemia. If patients have surgical contraindications or are unwilling to undergo surgery, drug therapy may be considered.
2. Drug treatment is not standardized
.
Misunderstanding: The appropriate drug is not selected according to the patient’s condition and drug characteristics, or the efficacy and side effects of the drug are not regularly monitored.
Correction: Drug therapy should be selected according to the patient’s condition and drug characteristics, such as aldosterone receptor antagonists such as spironolactone and eplerenone. In the course of treatment, blood pressure, blood potassium and other indicators should be monitored regularly, as well as possible side effects of drugs, such as hyperkalemia, hyponatremia and so on. If necessary, the dosage of drugs should be adjusted or the drugs should be changed according to the monitoring results.
3. Neglecting lifestyle adjustment
Myth: Medication is considered sufficient to control the disease without lifestyle adjustments.
Correction: Lifestyle adjustment is an important part of the treatment of primary aldosteronism. Patients should maintain healthy eating habits, reduce the intake of high-sodium foods and increase the intake of potassium salts. At the same time, moderate exercise, weight control, smoking cessation and alcohol restriction, maintain a good mentality and adequate sleep. These measures can help to reduce blood pressure, improve cardiovascular function and improve the quality of life.
III. Misunderstanding
of Follow-up and Monitoring
1. Insufficient
follow-up frequency
Misunderstanding: It is believed that as long as the patient’s symptoms are relieved, there is no need for frequent follow-up.
Correction: Patients with primary aldosteronism need long-term follow-up and monitoring to detect and deal with changes in the condition in a timely manner. The frequency of follow-up should be adjusted according to the patient’s condition and treatment effect, and it is generally recommended to follow up every 3 to 6 months. In the follow-up process, we should focus on the changes of blood pressure, blood potassium and other indicators, as well as the evaluation of drug efficacy and side effects.
2. Monitoring indicators are not comprehensive
Misunderstanding: only focus on blood pressure and potassium indicators, ignoring the monitoring of other related indicators.
Correction: In addition to blood pressure and potassium indicators, attention should also be paid to the monitoring of renal function, electrolyte balance, cardiovascular function and other related indicators. The changes of these indicators may reflect the development of the patient’s condition and the effect of treatment. Therefore, comprehensive and meticulous monitoring and evaluation should be carried out in the follow-up process.
To sum up, the treatment of primary aldosteronism needs to consider many aspects to avoid falling into the above misunderstanding. Through scientific and reasonable treatment plan and comprehensive lifestyle adjustment, the disease can be effectively controlled and the quality of life of patients can be improved.
Primary aldosteronism
