Academic Journal
[Stratified and graded diagnosis and treatment strategies for patients with primary aldosteronism].
| Τίτλος: | [Stratified and graded diagnosis and treatment strategies for patients with primary aldosteronism]. |
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| Συγγραφείς: | Wang XJ; Department of Endocrinology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China., Cao XP; Department of Endocrinology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China. |
| Πηγή: | Zhonghua yi xue za zhi [Zhonghua Yi Xue Za Zhi] 2026 Oct 13; Vol. 106 (37), pp. 3934-3938. |
| Τύπος έκδοσης: | English Abstract; Journal Article |
| Γλώσσα: | Chinese |
| Στοιχεία περιοδικού: | Publisher: Zhonghua yi xue hui Country of Publication: China NLM ID: 7511141 Publication Model: Print Cited Medium: Print ISSN: 0376-2491 (Print) Linking ISSN: 03762491 NLM ISO Abbreviation: Zhonghua Yi Xue Za Zhi Subsets: MEDLINE |
| Imprint Name(s): | Publication: Beijing : Zhonghua yi xue hui Original Publication: Beijing : Zhonghua yi xue hui. |
| Ιατρικοί όροι (MeSH): | Hyperaldosteronism*/diagnosis , Hyperaldosteronism*/therapy , Hyperaldosteronism*/classification, Humans |
| Περίληψη: | Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension and carries a greater risk of cardiorenal complications than essential hypertension. Recent domestic and international guidelines and consensus statements have proposed screening all patients with hypertension for PA. To cope with the massive patient base resulting from universal screening, this article explores practical schemes for the stratified and graded diagnosis and treatment of PA. By employing "non-drug withdrawal" and "minimal-drug withdrawal" testing protocols, PA screening can be feasibly implemented in primary care settings. Based on simple clinical parameters-including serum potassium, plasma aldosterone levels, and blood pressure-patients are stratified into mild, moderate, and severe categories, along with an estimated probability of unilateral PA. Patients with mild disease, unwilling to undergo surgery, or those who are not surgical candidates can receive medical therapy and follow-up directly at primary care facilities. For moderate-to-severe patients who are willing and eligible for surgery, referral to higher-level hospitals with specialized expertise is indicated, where confirmatory aldosterone suppression testing and adrenal venous sampling are performed for subtype classification. Unilateral disease is treated with surgical resection of the affected adrenal gland, whereas bilateral disease is managed medically. This approach enables timely and appropriate diagnosis and treatment of PA across a broader range of healthcare institutions, fulfilling the paradigm of "universal screening-stratified management-individualized therapy". |
| Competing Interests: | 所有作者声明不存在利益冲突 |
| Contributed Indexing: | Local Abstract: [Publisher, Chinese] 原发性醛固酮增多症（PA）是继发性高血压最常见的内分泌病因，较原发性高血压有更严重的心肾并发症风险。最新国内外指南、共识提出对所有高血压患者进行PA筛查。为应对全员筛查带来的庞大患者基数，该文结合最新指南探讨PA的分层、分级诊疗实践方案。根据“不停药”与“最小停药”方案，使PA在基层医疗机构普及筛查成为可能。根据血清钾、血浆醛固酮水平及血压等简易指标对PA进行轻、中、重度以及单侧PA概率分层，轻症、不愿手术或者不能手术患者直接在基层医疗机构进行药物治疗并随访。手术意愿且可手术的中、重度患者，则转诊至有专科资质的上级医院，应用醛固酮抑制试验和肾上腺静脉取血明确分型，单侧病变手术切除患侧肾上腺，双侧病变药物治疗。使这一常见疾病在更广泛的医疗机构得到及时、合理诊治，实现“全人群筛查-分层诊治-个性化治疗”。. |
| Entry Date(s): | Date Created: 20261010 Date Completed: 20261010 Latest Revision: 20261013 |
| Update Code: | 20261013 |
| DOI: | 10.3760/cma.j.cn112137-20250416-01034 |
| PMID: | 42855766 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 0376-2491 |
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| DOI: | 10.3760/cma.j.cn112137-20250416-01034 |