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
...gnosis...
ES recommends using the plasma aldosterone/renin...
Instead of proceeding directly to subt...
...n the setting of spontaneous hypokal...
...that all patients with PA undergo ad...
...that when surgical treatment is feasible a...
Younger patients (< age 35 years)...
...n patients with an onset of confir...
...patients with PA, ES suggests testing for g...
...1. Algorithm for the Detection, Confirmation, Su...
...s With High Prevalence of PAHaving...
.... Factors That May Lead to False-Pos...
...easurement of ARR: A Suggested Approach...
Table 4. ARR Cutoff Values, Depending on A...
...tions With Minimal Effects on Plasma A...
...6. PA Confirmatory TestsHaving troubl...
Treatment
Treatm...
...mmends unilateral laparoscopic adrenalectomy for p...
...unable or unwilling to undergo surgery,...
If an ARR-positive patient is unwilling or un...
...patients with GRA, ES recommends adminis...
...y of Systematic Reviews Addressing Management of P...
...ectomy vs. MR antagonists
...trol (M) ()699...
...erence in LV mass reduction (L) ()...
...of PAWeighted mean prevalence of...
...curacy of CT and MRI in diagnosing laterality...
...as a screening test for PADiagnostic accuracy...