Diagnosis and treatment of primary aldosteronism

Primary aldosteronism is the most common form of secondary hypertension. The detection of primary aldosteronism is of particular importance, not only because it provides an opportunity for a targeted treatment (surgical for APA and medical with mineralocorticoid receptor antagonists for BAH), but also because it has been extensively demonstrated that patients affected by PA are more prone to cardiovascular events and target organ damage than essential hypertensives. According to the Endocrine Society Guidelines diagnosis of PA is made following a rigorous flow-chart comprising screening, confirmation/exclusion testing and subtype diagnosis. In the present review we describe briefly the published diagnostic strategies of the Guidelines, highlighting new evidence that has become recently available and discuss issues that still need to be addressed by future research.