Primary Aldosteronism
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
...agnosis...
...s using the plasma aldosterone/renin ratio (ARR...
...d of proceeding directly to subtype clas...
...he setting of spontaneous hypokalemia, plasma r...
...recommends that all patients with PA und...
...recommends that when surgical treatment is fea...
...unger patients (< age 35 years) with spontane...
...n patients with an onset of confirmed PA...
...tients with PA, ES suggests testing for germline...
...ithm for the Detection, Confirmati...
Table 1. Groups With High Prevalence...
...ctors That May Lead to False-Positive or False...
...ement of ARR: A Suggested Approach A...
...R Cutoff Values, Depending on Assay and Based o...
...5. Medications With Minimal Effects on Plasma...
...ble 6. PA Confirmatory TestsHaving tro...
Treatment
Treatme...
...nds unilateral laparoscopic adrenalectom...
...atient is unable or unwilling to und...
...tive patient is unwilling or unable to u...
...ents with GRA, ES recommends administering the low...
...ble 8. Summary of Systematic Review...
...enalectomy vs. MR antagoni...
...trol (M) ()699...
...o difference in LV mass reduction (L...
...Weighted mean prevalence of elevated ARRs an...
...T and MRI in diagnosing laterality of...
... ARR as a screening test for PAD...