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Primary aldosteronism: an update on screening, diagnosis and treatment
Gian Paolo Rossi1, Achille Cesare Pessina, Anthony M Heagerty
1DMCS, Clinica Medica 4, Policlinico Universitario, Padova, Italy. gianpaolo.rossi@unipd.it
Insights
Primary aldosteronism, a common cause of hypertension, damages organs and increases cardiovascular events. Early diagnosis and treatment are crucial for better patient outcomes.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Nephrology
Background:
- Primary aldosteronism is more prevalent than previously thought.
- It leads to significant organ damage (heart, vessels, kidneys) and cardiovascular events.
- Hypertension and hypokalemia associated with primary aldosteronism are treatable with timely diagnosis.
Purpose of the Study:
- To update information on screening and exclusion tests for primary aldosteronism.
- To outline strategies for differentiating primary aldosteronism subtypes.
- To emphasize the importance of an aggressive diagnostic approach in hypertensive patients.
Main Methods:
- Literature review.
- Analysis of authors' personal experience.
Main Results:
- Cost-effective screening strategies for primary aldosteronism are available in most centers.
- Subtype differentiation (e.g., aldosterone-producing adenoma vs. idiopathic hyperaldosteronism) requires specialized tertiary referral centers.
Conclusions:
- Identifying curable forms of primary aldosteronism benefits both patients and clinicians.
- An aggressive diagnostic approach is essential for specific hypertensive patient subgroups at higher risk or who stand to gain most from accurate diagnosis.
Background:
Primary aldosteronism is much more common than previously held; it implies an excessive organ damage to the heart, vessels and kidney, which translates into an excess of cardiovascular events. These two features, along with the fact that the arterial hypertension and the hypokalemia can be corrected with a timely diagnosis and an appropriate therapy, warrant an aggressive diagnostic approach in hypertensive patients.
Objectives:
To provide updated information on the screening and exclusion tests for primary aldosteronism and to illustrate the strategy that can be followed for primary aldosteronism subtype differentiation.
Design:
Review of the literature and personal experience of the authors.
Results:
The available evidence showed that a cost-effective strategy for the screening of patients with primary aldosteronism can be exploited at most centres. At variance, the identification of primary aldosteronism subtypes, for example, the differentiation of patients with an aldosterone-producing adenoma from those with idiopathic hyperaldosteronism should be undertaken at tertiary referral centres.
Conclusion:
The identification of a curable form of primary aldosteronism can be much rewarding for the patient and the doctor. Thus, an aggressive diagnostic approach is mandatory at least in some subgroups of hypertensive patients who are at higher prior risk of primary aldosteronism or can benefit more from an accurate diagnosis.
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