Primary Aldosteronism

Publication Date: May 1, 2016

Key Points

Key Points

Primary aldosteronism (PA) is a group of disorders in which aldosterone production is inappropriately high for sodium status, relatively autonomous of the major regulators of secretion (angiotensin II, plasma potassium concentration), and nonsuppressible by sodium loading.

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

ES recommends using the plasma aldosterone/ren...


...tead of proceeding directly to subtyp...

...er, in the setting of spontaneous hypokalemi...


...S recommends that all patients with PA undergo a...


...mmends that when surgical treatment is feasible...

...r patients (< age 35 years) with spo...


...with an onset of confirmed PA earlier than...

...ng patients with PA, ES suggests testing f...


...1. Algorithm for the Detection, Confirmation...


...s With High Prevalence of PAHaving trouble viewi...


...Factors That May Lead to False-Positive...


...Measurement of ARR: A Suggested Approach...


...utoff Values, Depending on Assay and Based on Whe...


...le 5. Medications With Minimal Effects...


...onfirmatory TestsHaving trouble vie...


Treatment

...reatme...

...ecommends unilateral laparoscopic adrenalectom...

...is unable or unwilling to undergo surgery, ES r...

...sitive patient is unwilling or unable to...


...n patients with GRA, ES recommends administering t...


...able 8. Summary of Systematic Reviews Add...

...enalectomy vs. MR antagonists...

...control (M) ()69...

...in LV mass reduction (L) ()699...

...Weighted mean prevalence of elevated...

Accuracy of CT and MRI in diagnosing laterali...

...a screening test for PADiagnostic accuracy...