[Primary hyperaldosteronism].

Area of Science:

• Endocrinology
• Nephrology
• Internal Medicine

Background:

• Primary hyperaldosteronism (PHA) is characterized by autonomous aldosterone secretion from the adrenal gland.
• It frequently leads to therapy-resistant hypertension and may be associated with hypokalemia.
• Common etiologies include aldosterone-producing adenomas, idiopathic hypersecretion, unilateral hyperplasia, and genetic forms like glucocorticoid-remediable aldosteronism (GRA).

Purpose of the Study:

• To outline a phased diagnostic approach for primary hyperaldosteronism.
• To detail methods for confirming PHA biochemically and identifying its underlying cause.
• To describe current therapeutic strategies for different forms of PHA.

Main Methods:

• Biochemical confirmation involves measuring plasma renin and aldosterone levels under standardized conditions, excluding interfering medications.
• Confirmatory tests include assessing aldosterone suppression after saline volume expansion.
• Imaging (CT/MRI) and adrenal vein sampling are used to determine the cause, differentiating unilateral from bilateral disease.

Main Results:

• PHA is diagnosed in patients with suppressed plasma renin and elevated aldosterone, or when aldosterone fails to suppress after saline loading.
• Imaging can identify unilateral adenomas, while adrenal vein sampling helps lateralize aldosterone production if imaging is inconclusive.
• All PHA forms respond to spironolactone; unilateral disease may be treated with adrenalectomy, and GRA with dexamethasone.

Conclusions:

• Accurate diagnosis of PHA requires a systematic biochemical and imaging-based approach.
• Effective management strategies exist, tailored to the specific cause of primary hyperaldosteronism.
• Timely diagnosis and treatment of PHA can significantly improve outcomes for patients with resistant hypertension.