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
...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,...
...ps With High Prevalence of PAHaving troub...
...actors That May Lead to False-Positiv...
...le 3. Measurement of ARR: A Suggested Approach...
...off Values, Depending on Assay and Based on Whet...
...e 5. Medications With Minimal Effects on Plasm...
...Confirmatory TestsHaving trouble viewing...
Treatment
Treat...
...s unilateral laparoscopic adrenalectomy for pati...
...unable or unwilling to undergo surgery, ES recom...
...positive patient is unwilling or unable to un...
...with GRA, ES recommends administering the lowe...
...Table 8...
...lectomy vs. MR antagonists...
...ontrol (M) ()69...
...ference in LV mass reduction (L) ()699...
...e of PAWeighted mean prevalence of el...
...curacy of CT and MRI in diagnosin...
...as a screening test for PADiagnostic accuracy es...