Primary Aldosteronism
Key Points
Key Points
Such inappropriate production of aldosterone causes hypertension, cardiovascular damage, sodium retention, suppression of plasma renin, and increased potassium excretion that (if prolonged and severe) may lead to hypokalemia.
- Only 9–37% of patients with PA have hypokalemia.
PA is commonly caused by an adrenal adenoma, unilateral or bilateral adrenal hyperplasia (BAH), or in rare cases adrenal carcinoma or inherited conditions of familial hyperaldosteronism.
Cross-sectional and prospective studies report PA in >5% and possibly >10% of hypertensive patients, both in general and in specialty settings.
Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential hypertension and the same degree of BP elevation.
Specific treatments, either by mineralocorticoid receptor (MR) antagonists or unilateral adrenalectomy, are available that ameliorate the impact of this condition on important patient outcomes.
Diagnosis
...agnosis...
...ommends using the plasma aldostero...
...oceeding directly to subtype classification, ES re...
...r, in the setting of spontaneous hypokalemia...
...ds that all patients with PA undergo adrenal co...
...s that when surgical treatment is feasible...
...nts (< age 35 years) with spontaneo...
...nts with an onset of confirmed PA...
...ng patients with PA, ES suggests testing for germl...
...1. Algorithm for the Detection, Confirmation,...
...s With High Prevalence of PAHaving trouble...
.... Factors That May Lead to False-Positive...
...Measurement of ARR: A Suggested Approach A....
...ARR Cutoff Values, Depending on Assay and Base...
...edications With Minimal Effects on Plasma Aldoster...
Table 6. PA Confirmatory TestsHaving tro...
Treatment
...eatmen...
...mmends unilateral laparoscopic adrenalectomy for...
...t is unable or unwilling to undergo surgery...
...tive patient is unwilling or unable to...
...n patients with GRA, ES recommends administering t...
Table 8. Summary of Systematic Reviews Addres...
...drenalectomy vs. MR an...
...trol (M) ()699...
...in LV mass reduction (L) ()699...
...nce of PAWeighted mean prevalence of elev...
...acy of CT and MRI in diagnosing l...
...of ARR as a screening test for P...