Selection of patients for surgery for primary aldosteronism

1. Primary aldosteronism is a condition characterized by renin suppression and various degrees of hypertension and hypokalemia caused by aldosterone hypersecretion. 2. The adoption of the aldosterone-to-renin ratio determination as a screening test has led to an increase in the prevalence of diagnosed cases of primary aldosteronism. 3. Primary aldosteronism is confirmed by the demonstration of either sustained absolute aldosterone hypersecretion, or non-suppressible aldosterone hypersecretion. 4. Computed tomography and adrenal vein sampling can then be used to distinguish between idiopathic primary aldosteronism and the surgically remediable forms: aldosterone-producing adenoma and primary adrenal hyperplasia. 5. In patients with aldosterone-producing adenoma or primary adrenal hyperplasia, unilateral adrenalectomy generally results in the normalization of aldosterone secretion and kalemia, but normotension is achieved in only half of the cases. Nevertheless, in many cases without hypertension cure, adrenalectomy leads to an improvement in hypertension control with lower blood pressure levels and/or less antihypertensive medication.