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Management and Outcomes of Primary Aldosteronism in Pregnancy: A Systematic Review
Hypertension ( IF 8.3 ) Pub Date : 2022-06-10 , DOI: 10.1161/hypertensionaha.121.18858
Viola Sanga 1, 2 , Giacomo Rossitto 1, 3 , Teresa Maria Seccia 1 , Gian Paolo Rossi 1
Affiliation  

Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Moreover, we found that published PAP cases fell into 4 main groups differing for management and outcomes: (1) unilateral medically treated, (2) unilateral surgically treated, (3) bilateral medically treated and (4) familial forms. Results showed that complications involved 62.2% of pregnant women with nonfamilial PA and 18.5% of those with familial hyperaldosteronism type I. Adrenalectomy during pregnancy in women with PAP did not improve maternal and fetal outcomes, over medical treatment alone. Moreover, cure of maternal hypertension and mother and baby outcome were better when unilateral PA was discovered and surgically treated before or after pregnancy. Therefore, fertile women with arterial hypertension should be screened for PA before pregnancy and, if necessary, subtyped to identify unilateral forms of PA. This will allow to furnish adequate counseling, a chance for surgical cure and, therefore, for a pregnancy not complicated by aldosterone excess.

中文翻译:

妊娠期原发性醛固酮增多症的管理和结局:系统评价

妊娠期原发性醛固酮增多症 (PA) (PAP) 可能是一种严重的疾病,难以诊断。本研究旨在帮助诊断 PAP,并根据使用人群、干预、比较和结果搜索策略检索到的证据提供有关 PAP 管理的建议。基于正常妊娠中醛固酮和肾素的变化,我们开发了一个列线图,可以识别 PAP 病例。此外,我们发现已发表的 PAP 病例分为 4 个主要组,在管理和结果上有所不同:(1)单侧药物治疗,(2)单侧手术治疗,(3)双侧药物治疗和(4)家族型。结果显示,62.2% 的非家族性 PA 孕妇和 18.5% 的家族性 I 型醛固酮增多症孕妇出现并发症。与单独的药物治疗相比,PAP 女性在妊娠期间进行肾上腺切除术并不能改善母婴结局。此外,在孕前或孕后发现单侧肺动脉瓣并进行手术治疗的产妇高血压治愈率和母婴结局均较好。因此,患有高血压的有生育能力的女性应在怀孕前进行 PA 筛查,并在必要时进行亚型分析以识别单侧形式的 PA。这将允许提供足够的咨询、手术治愈的机会,因此,对于不会因醛固酮过多而并发的妊娠。因此,患有高血压的有生育能力的女性应在怀孕前进行 PA 筛查,并在必要时进行亚型分析以识别单侧形式的 PA。这将允许提供足够的咨询、手术治愈的机会,因此,对于不会因醛固酮过多而并发的妊娠。因此,患有高血压的有生育能力的女性应在怀孕前进行 PA 筛查,并在必要时进行亚型分析以识别单侧形式的 PA。这将允许提供足够的咨询、手术治愈的机会,因此,对于不会因醛固酮过多而并发的妊娠。
更新日期:2022-06-10
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