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Updated: Jul 15, 2026
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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Detecting and treating primary aldosteronism: primary aldosteronism.
F Mantero1, M J Mattarello, N M E Albiger
1Division of Endocrinology, Department of Medical and Surgical Sciences, University of Padua, Italy. franco.mantero@unipd.it
Summary
Primary aldosteronism (PA), a common cause of hypertension, is increasingly detected using the plasma aldosterone concentration to plasma renin activity ratio (PAC/PRA). Early screening and diagnosis are crucial for managing hypertension and preventing cardiovascular damage.
Area of Science:
- Endocrinology
- Nephrology
- Cardiology
Background:
- Primary aldosteronism (PA) is the most prevalent cause of mineralocorticoid hypertension.
- Increased detection rates of PA are observed with the use of the plasma aldosterone concentration to plasma renin activity ratio (PAC/PRA) for screening hypertensive patients.
- Idiopathic bilateral adrenal hyperplasia (IHA) and aldosterone-producing adrenal adenoma (APA) are the primary causes of PA, with rarer forms including glucocorticoid-remediable aldosteronism (GRA) and carcinomas.
Purpose of the Study:
- To outline the diagnostic and management strategies for primary aldosteronism.
- To emphasize the importance of screening high-risk patients for PA.
- To differentiate between the subtypes of PA for appropriate treatment selection.
Main Methods:
- Screening for PA using the PAC/PRA ratio in patients with hypertension, hypokalemia, family history of early stroke, or resistant hypertension.
- Confirmation of diagnosis with sodium loading tests or captopril tests following a high PAC/PRA ratio.
- Subtype differentiation using adrenal gland imaging and adrenal venous sampling when necessary.
- Genetic testing for the detection of GRA.
Main Results:
- The PAC/PRA ratio has significantly increased the detection rate of PA.
- Adrenal gland imaging and adrenal venous sampling are key for differentiating APA from IHA.
- Genetic testing aids in identifying GRA.
- Surgical intervention is the preferred treatment for APA, while medical management is used for IHA.
Conclusions:
- Early screening and accurate diagnosis of PA are essential for managing hypertension and preventing associated complications.
- Treatment strategies, including surgery for APA and medical therapy for IHA, aim to normalize aldosterone levels or block its effects.
- Effective management of PA reduces the morbidity and mortality linked to hypertension, hypokalemia, and cardiovascular damage.
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