Zubryk I. Diagnosis and selection of treatment tactic in patients with primary aldosteronism

The thesis is devoted to the improving diagnostic protocol and the development of a differentiated approach to the selection of treatment for patients with primary aldosteronism (PA). The study analyzes the results of diagnosis and treatment of 56 patients with PA. During examination of patients who were divided into three study groups: 1st group included 26 (46.4 %) patients, underwent surgery using endoscopic techniques (laparoscopy) (laporoscopic adrenalectomy / laporoscopic adrenalectomy); 2nd group included 16 (28.6 %) patients who performed endovascular treatment with roentgenoendovascular destruction of adrenal gland; 3rd group included 14 (25 %) patients who received conservative treatment, it was not found statistically significant difference between men and women in indicators of BMI, history of disease duration, size formations adrenal body, blood pressure (BP), aldosterone, renin, aldosterone to renin ratio (ARR) and potassium (p > 0.05). Investigated reliable statistical correlative relationship between body mass index (BMI) and aldosterone level (r = +0.35; p < 0.05). The results rank correlation analysis revealed no reliable statistical relationship between the duration of illness of patients' medical history and BP (p > 0.05). Duration of history of the disease did not affect the level of aldosterone and potassium concentrations in patients with PA (p > 0.05). In patients it was found a correlation between aldosterone levels in plasma and size diastolic blood pressure (DBP) (r = +0.28; p < 0.05), indicating that the effect of the hormone on hemodynamics. As for the impact of aldosterone concentration on systolic blood pressure (SBP), significant correlation was not found (p > 0.05). During the analysis of research results among patients depending on the size of adrenal gland adenomas according to computer tomography (CT) and level aldosteronemia was not found (p > 0.05). The results of CT and adrenal vein sampling (AVS) show that of the 36 patients for whom AVS performed in 10 people (27.7 %). CT data do not coincide with the results of AVS, 6 (16.7 %) cases of which the process was bilateral. The size of adenomas in these patients according to CT ranged from 6 to 30.91 mm, median 9.93 (7.00; 26.43) mm. When the procedure, vascular architectonics of the adrenal body was studied by conducting phlebography of the adrenal body. Phlebography was performed to verify venous collaterals between the veins of the adrenal body and the distal branches of the diaphragmatic veins. The data obtained in conjunction with the results of AVS were analyzed when deciding on a patient's treatment tactics (Patent of Ukraine for utility model No. 116969 dated 12/06/2017). Analysis of echocardiographic examination in patients with PA revealed deviation of longitudinal (LDLV), circular (CDLV) and global (GDLV) deformation of the left ventricle (LV) of myocardium at normative values of ejection fraction (EF) in men. No correlation was found between aldosteronemia level and echocardiographic indices, but correlation with ARR correlation was observed. Thus, patients with PA were found to have a significant negative correlation between the mean strength of the LDLV level and the ARR correlation (r = -0.68; p < 0.05), which suggests that this factor may be influenced by myocardial remodeling processes.