Primary Aldosteronism; A Review of Diagnosis and Management

Abstract Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized respectively by bilateral or unilateral involvement of the adrenal gla...

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Bibliographic Details
Published in:The American journal of the medical sciences 2016
Main Authors: Gyamlani, Geeta, MD, Headley, Carol M., DNSc, ACNP, Naseer, Adnan, MD, Valaulikar, Ganpat S., MD, Geraci, Stephen A., MD
Format: Article
Language:English
Subjects:
Internal Medicine
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Summary:Abstract Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized respectively by bilateral or unilateral involvement of the adrenal glands. When there is suspicion for the presence of PA, a plasma aldosterone/renin ratio should be obtained initially. Localization to determine adrenal gland involvement is done by imaging, with computerized tomography or magnetic resonance imaging. After imaging, adrenal vein sampling is done to establish treatment options. Patients with unilateral disease who are good surgical candidates are most appropriately managed with adrenalectomy. A biochemical cure is almost certain following adrenalectomy, however only 30-50% of patients will show adequate blood pressure improvement. Patients with bilateral adrenal disease and those believed not to be surgical candidates are managed with mineralocorticoid antagonists.
ISSN:0002-9629
DOI:10.1016/j.amjms.2016.06.015