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

...commends using the plasma aldosterone/renin rat...


...stead of proceeding directly to subtyp...

...er, in the setting of spontaneous hypokalemia, p...


...commends that all patients with PA undergo a...


...that when surgical treatment is feasib...

...(< age 35 years) with spontaneous hypokalem...


...tients with an onset of confirmed PA earlier th...

...atients with PA, ES suggests testing...


...igure 1. Algorithm for the Detection,...


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...actors That May Lead to False-Positiv...


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Treatment

Treat...

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...with GRA, ES recommends administering the lowe...


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...as a screening test for PADiagnostic accuracy es...