The application of precision analysis allows the diagnosis of endocrine arterial hypertension – Health and Medicine

2023-10-29 02:18:54

Diagnosis in these cases is essential to be able to carry out individualized and precise treatment that helps prevent complications.

Screening and early detection is also crucial in patients with primary hyperaldosteronism, a disorder whose main symptoms are high blood pressure and hypokalemia, to establish appropriate treatments, improve the patient’s quality of life and even achieve a cure for the disease.

Arterial Hypertension (AH) is one of the most frequent risk factors in patients with cardiovascular pathologies, while secondary hypertension of endocrinological etiology is present in up to 10-15% of hypertensive patients, despite being a pathology. frequently underdiagnosed worldwide. Added to this is that patients with secondary hypertension have a higher risk of adverse events and higher mortality throughout life, mainly from cardiovascular causes.

Therefore, early diagnosis in these cases is key to being able to carry out individualized and precise treatment that helps prevent complications. “Accurate and widely available diagnostic tests are urgently required to improve the screening and diagnosis of endocrine HTN,” clarifies Felicia Hanzu, endocrinology consultant at the Hospital Clínico de Barcelona.

In this sense, the application of precision analysis of omics sciences such as genomics, proteomics or metabolomics allows the detection of key biomarkers in the diagnosis of endocrine arterial hypertension. Thus, thanks to these omics sciences it is possible to know the characteristics of organisms at different molecular levels, in addition to revealing the network of interactions between molecular levels and providing a complete dynamic vision of the organism.

“In a European multinational study, this innovative approach has been used to identify the subtypes of endocrine hypertension, Cushing’s syndrome, paraganglioma and primary arterial hypertension and it has been possible to detect the omics fingerprint of 57 markers that allow differential diagnosis between the cluster. formed by the main etiologies of endocrine hypertension and primary arterial hypertension. Without a doubt, we are at the beginning of the bioinformatics path,” explains Hanzu.

Thus, the great challenge of integrative and multi-omics techniques lies in the identification of diagnostic molecular biomarkers through the analysis and integration into machine learning algorithms of clinical and biological data from large cohorts of patients.

Early diagnosis of primary hyperaldosteronism

Early diagnosis is also key in the approach to primary hyperaldosteronism, a disorder that is underdiagnosed today and is characterized by excess production of aldosterone autonomously by one or both adrenal glands, and whose most typical symptoms are the presence of hypertension. (which can be mild to severe) and hypokalemia (low potassium concentration in the blood). In this sense, the experts highlight “One of the main reasons why we insist so much on the importance of following the screening recommendations and thus being able to diagnose primary hyperaldosteronism, is because we are aware of all the deleterious effects associated with excess production of aldosterone, beyond arterial hypertension and hypokalemia”

There are multiple studies that demonstrate that patients with primary hyperaldosteronism have a higher risk of cardiovascular, renal and metabolic diseases than patients with essential arterial hypertension. Thus, among the most frequent cardiovascular, renal and metabolic manifestations of primary hyperaldosteronism are atrial fibrillation, left ventricular hypertrophy, acute myocardial infarction, heart failure, stroke, chronic kidney disease, diabetes mellitus and sleep apnea syndrome, among others.

Hence the importance of early diagnosis of primary hyperaldosteronism, especially in those who present unilateral forms of the disease and in whom it is detected correctly and early, since “there is the possibility of reversing or at least reducing the increase in morbidity and mortality.” associated with primary hyperaldosteronism, if we establish adequate treatment early, the treatment will also improve the patient’s quality of life and even achieve cure of the disease if it is a unilateral form of hyperaldosteronism,” the specialist noted.

In fact, according to Dr. Araujo, “it is estimated that approximately 50-60% of cases of primary hyperaldosteronism are unilateral forms and, when these cases undergo an adrenalectomy, in 80-90% of cases it is resolved. hyperaldosteronism. This leads to a reduction in cardiovascular and metabolic risk, resolution of hypokalemia and cure or improvement of arterial hypertension in 80% of cases.”

Regarding the advances in the approach and management of primary hyperaldosteronism that have occurred in recent years, they focus especially on diagnosis (thanks to metabolomics, ultrarapid cortisol methods used during adrenal vein catheterization, greater knowledge of the causes genetics that lead to the disease and the creation of records); as well as surgical treatment (with new techniques such as partial adrenalectomy) and medical treatment (antihypertensives such as aldosterone synthetase inhibitors, which could be very useful in primary hyperaldosteronism).

Endocrinology and menopause

Androgenic excess is mainly manifested by the presence of excessive amounts of male hormones. The typical profile of patients who usually suffer from this alteration are usually women of childbearing age, “especially in the second and stubborn decades of life, who attend consultation for a wide spectrum of symptoms ranging from excess male hair to menstruation disorders. or difficulty getting pregnant, among others,” says Héctor F. Escobar-Morreale, professor and head of the Endocrinology and Nutrition Service at the Ramón y Cajal Hospital in Madrid.

In the case of women who suffer from this androgenic excess during menopause, they may suffer from excess hair, alopecia and even “alterations in the external genitalia with growth of the clitoris and the labia majora of the vagina, decrease in female secondary sexual characteristics with atrophy. mammary gland or redistribution of body fat to the abdominal region,” said the expert.

Some of these cases, fortunately rare, appear due to benign or malignant tumors that secrete male hormone in large quantities. In addition, during the process of converting the male hormone into female in body fat, there is an increased risk of estrogen-dependent gynecological tumors such as those of the breast or endometrium. For this reason, the specialist emphasizes that “its early detection through imaging techniques is essential for its immediate diagnosis and treatment.”

In this sense, it is worth highlighting the work that the Endocrinology services acquire in the approach of these patients, playing an essential role in differentiating the changes of normal menopause from symptoms of diseases of androgen excess, in the initial urgent screening of tumor cases and in the identification and treatment of the causes of excess male hormone, among other aspects. L.D. B. (SyM)