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Primary aldosteronism in pregnancy.

Vittorio Forestiero1, Elisa Sconfienza1, Paolo Mulatero2

  • 1Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy.

Reviews in Endocrine & Metabolic Disorders
|May 10, 2022
PubMed
Summary

Primary aldosteronism (PA) during pregnancy presents diagnostic challenges due to physiological changes. Eplerenone is a safe treatment option, while adrenalectomy may be considered for severe cases.

Keywords:
DiagnosisManagementPregnancyPrimary aldosteronism

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Cardiology

Background:

  • Primary aldosteronism (PA) is the leading cause of secondary hypertension.
  • Hypertensive disorders affect 5-10% of pregnancies, yet PA diagnosis in this period is rare (<80 cases).

Purpose of the Study:

  • To review the pathophysiology, natural history, diagnosis, and treatment of PA during pregnancy.
  • To highlight the complexities of diagnosing and managing PA in pregnant individuals.

Main Methods:

  • Literature review focusing on PA in pregnancy.
  • Discussion of diagnostic challenges and treatment options.
  • Analysis of hormonal changes and their impact on pregnancy.

Main Results:

  • PA diagnosis in pregnancy is difficult due to physiological RAAS alterations and test contraindications.
  • Pregnancy course with PA varies, from BP improvement to severe hypertension with complications.
  • Eplerenone shows safety and efficacy in pregnant women; adrenalectomy is a consideration for specific cases.

Conclusions:

  • Accurate diagnosis of PA in pregnancy relies on identifying low renin and high aldosterone.
  • Mineralocorticoid receptor antagonists, particularly eplerenone, are key treatments.
  • Surgical intervention (adrenalectomy) may be necessary in select, severe cases during pregnancy.