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

...Dia...

...ends using the plasma aldosterone/renin ra...


...ead of proceeding directly to subtype classif...

...setting of spontaneous hypokalemia,...


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


...mends that when surgical treatment i...

...unger patients (< age 35 years) with spont...


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

...very young patients with PA, ES suggest...


...rithm for the Detection, Confirmatio...


...ups With High Prevalence of PA...


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


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


.... ARR Cutoff Values, Depending on Ass...


...e 5. Medications With Minimal Effects on Pla...


...firmatory Tests Test and Proc...


Treatment

...Tre...

...mends unilateral laparoscopic adre...

...is unable or unwilling to undergo...

...positive patient is unwilling or unab...


...n patients with GRA, ES recommends a...


...Table 8....

...nalectomy vs. MR antagoni...

...ontrol (M) ()699...

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

Prevalence of PAWeighted mean prevalence of eleva...

...CT and MRI in diagnosing laterality of a...

...e of ARR as a screening test for P...