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Primary aldosteronism and pregnancy.

Ester Landau1, Laurence Amar2

  • 1Université Paris-Descartes Faculty of Medicine, 75006 Paris, France.

Annales D'Endocrinologie
|May 10, 2016
PubMed
Summary

Primary aldosteronism (PA) complicates pregnancies, posing high risks for mothers and babies. Early diagnosis and pre-conception treatment, like adrenalectomy for unilateral PA, are crucial for better outcomes.

Keywords:
GrossesseHyperaldostéronisme primairePregnancyPrimary aldosteronism preeclampsiaPréclampsieSpironolactone

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Area of Science:

  • Endocrinology
  • Obstetrics
  • Nephrology

Background:

  • Hypertension complicates 8% of pregnancies; 10% of hypertension cases stem from primary aldosteronism (PA).
  • Diagnosing PA during pregnancy is challenging due to physiological changes in the renin-angiotensin system.
  • PA in pregnancy is suspected in hypertensive patients with hypokalemia.

Purpose of the Study:

  • To review existing literature on primary aldosteronism in pregnancy.
  • To analyze maternal and fetal outcomes in pregnancies affected by PA.
  • To provide recommendations for managing PA during pregnancy.

Main Methods:

  • A comprehensive literature review was conducted.
  • Data from 40 pregnancies in patients with PA were analyzed.
  • Outcomes and management strategies were evaluated.

Main Results:

  • PA in pregnancy represents a high-risk condition associated with maternal and fetal complications.
  • Pre-conception planning and treatment are recommended.
  • Surgical intervention (adrenalectomy) for unilateral PA before conception is advised.
  • Specific antihypertensive medications with low teratogenicity risk are recommended during pregnancy.

Conclusions:

  • PA significantly increases pregnancy risks, necessitating careful management.
  • Programmed pregnancy with pre-conception adrenalectomy for unilateral PA is optimal.
  • Management involves careful drug selection and consideration of adrenalectomy during pregnancy for refractory cases.