Approaching Primary Aldosteronism as a Common Disease

Abstract

Objective: To describe the approach to primary aldosteronism as a common disease.

Methods: The study methods involved are literature review and personal experience.

Results: Primary aldosteronism is the most common form of endocrine hypertension, yet screening rates are abysmally low. Major reasons for low screening rates include misconceptions about the drug interference and limited access to adrenal vein sampling expertise for subtyping. The workup of primary aldosteronism is greatly simplified by considering the condition as a continuum with low-renin primary hypertension. Thus, the purpose of the evaluation is not a yes/no dichotomous diagnosis but rather a gauging of how likely the patient has a lateralized source and will benefit from unilateral adrenalectomy. This approach favors the selective rather than universal use of cross-sectional imaging and adrenal vein sampling but promotes the liberal use of mineralocorticoid-receptor antagonists.

Conclusion: The review will develop a practical approach to the patient using a series of questions with answers from the literature.

Keywords: aldosterone; cortisol; hypertension; micronodule; mutation; renin.