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Ipertensione e iperaldosteronismo

L'iperaldosteronismo è una condizione clinica caratterizzata da un eccesso di produzione di aldosterone da parte dei surrene. La maggior parte dei casi di iperaldosteronismo primitivo è causata da adenoma solitario o da iperplasia della corticale del surrene.L' iperaldosteronismo è caratterizzato da: Ipertensione severa,  resistente al trattamento farmacologico. Il percorso diagnostico dell’iperaldosteronismo primitivo si articola in tre fasi: screening; conferma e diagnosi di sottotipo

L’ipertensione è un problema estremamente diffuso e causa la morte di 7,5  milioni di persone.
In Italia colpisce 16 milioni di persone, il 33% uomini e il 31% donne.
Questi dati sono stati forniti dalla SIIA ( Società Italiana dell’Ipertensione Arteriosa)

Che cos’è l’iperaldosteronismo?

L’iperaldosteronismo è una condizione clinica caratterizzata da un eccesso di produzione di aldosterone da parte dei surreni. L’ipertensione da iperaldosteronismo costituisce, a seconda delle casistiche esaminate, l’1- 11% di tutte le forme di ipertensione arteriosa e trova il suo meccanismo eziopatogenetico nell’iperproduzione  di aldosterone. La maggior parte dei casi di iperaldosteronismo primitivo è causata daadenoma solitarioo daiperplasia della corticale del surrene.L’aldosterone determina un incremento dei valori pressori attraverso l’aumento del volume plasmatico, del contenuto di sodio e delle resistenze periferiche.




Cause di iperaldosteronismo primitivo

Origine surrenalica

  • Eccesso di aldosterone
  • Adenoma secernente aldosterone
  • Iperplasia surrenalica
  • Carcinoma surrenalico secernente aldosterone
  • Tumori extra surrenalici (carcinoma ovaricosecernente aldosterone)
  • Iperaldosteronismo familiare di tipo 1

Eccesso di desossicorticosterone

  • Tumori secernenti desossicorticosterone
  • Carenza di 11 β-idrossilasi, 17α-idrossilasi

Origine renale

  • Carenza 11 β-idrossilasi(congenita e acquisita)
  • Mutazione del recettore mineralcorticoide
  • Pseudoipoaldosteronismo 

Quali sono i sintomi dell’iperaldosteronismo?

L’ iperaldosteronismo è caratterizzato da:

  • Ipertensionesevera,  resistente al trattamento farmacologico 

La maggior parte dei sintomi riscontrati nell’ iperaldosteronismo è da attribuire all’ ipokaliemia:

  • Astenia
  • Turbe del batmotropismo ventricolare
  • Poliuria
  • Polidipsia
  • Intolleranza glucidica

Esame obiettivo

All’esame obiettivo possono essere presenti paralisi temporanee o intermittenti e spasmi muscolari.

 

 




 

Esami  diagnostici

  • LaTCad alta definizione può identificare adenomi surrenalici delle dimensioni di pochi millimetri.
  • LaRisonanza magnaetica  è dotata di maggiore sensibilità ma minore specificità.
  • Lascintigrafiaconsente di distinguere tra adenomi che rimangono visibili e iperplasia che non mostra captazione di radiofarmaco, in quanto inibita.
  • L’ipokaliemiaspontanea è presente nella maggior parte dei pazienti affetti da iperaldosteronismo.
  • Nei pazienti con adenoma, ma non in quelli con iperplasia, possono essere riscontrati in circolo precursori o forme ibride di steroidi.
  • L’attività  reninica plasmaticadi solito è soppressa e non è sensibile al clinostatismo.
  • Il prelievo selettivo delle vene surrenali rappresenta il miglior test diagnostico per dimostrare la lateralizzazione della produzione di aldosterone.
  • La misurazione dell’aldosterone e del cortisoloviene eseguita su campioni di sangue prelevati in vena cava inferiore e allo sbocco delle vene surrenaliche.

Come si cura l’peraldosteronismo?

La terapia dell’ipertensione da iperaldosteronismo varia in funzione della sua eziologia: in caso di adenoma sono più indicate le procedure chirurgiche, mentre in caso di iperplasia è da  preferire la terapia medica. La tecnica maggiormente diffusa è lasurrenectomiamonolaterale per via laparoscopica. Tale procedura assicura la guarigione del 33% dei casi, negli altri casi un miglior controllo della pressione arteriosa. La persistenza di valori elevati di pressione arteriosa dopo surrenectomia deve far pensare a:

  • Coesistenza di ipertensione essenziale,a come si verifica nel 20% dei casi
  • Danno renale indotto da ipertensione secondaria
  • Persistenza di tessuto adenomatoso post surrenectomia.

La terapia medica prevede l’uso di antagonisti recettoriali dell’aldosterone come lo spironolattone o eplerenone in monoterapia o in terapia di combinazione con diuretico tiazidico.

 

 




 

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Ipertensione
  Serendipity360 Benessere e Salute  , , 

La pressione sanguigna è  il risultato dell’eiezione da parte del ventricolo sinistro del cuore

in un minuto..

>Vai all’articolo

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Alimentazione e stile di vita nell’ipertensione
  lunazzola@gmail.com 

 L’ipertensione considerata un  “killer silenzioso” rappresenta un gravissimo fattore di rischio per le malattie cardiovascolari e l’ictus. Per questi motivi si raccomanda di…

>Vai all’articolo

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Ipertensione nefrovascolare

 lunazzola@gmail.com  

Con il termine “ipertesione nefrovascolare” viene definita  la condizione di ipertensione arteriosa causata dall’ ischemia renale, la cui eziologia..

>Vai all’articolo

 

 

 

(Bibl.Rugarli,  medicina interna sistematica 1,Claudio Rugarli, sett. ediz. Edra s.p.a. Milano, ott. 2017)

 

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