[Primay hyperaldosteronism--diagnostic and treatment]

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Nephrology

Background:

• Primary hyperaldosteronism (PHA) involves excess aldosterone synthesis, independent of the Renin-Angiotensin-Aldosterone-System (RAAS).
• PHA affects approximately 10% of patients in hypertension centers and is linked to worse outcomes, even in normokalemic individuals, compared to essential hypertension.
• Identifying PHA is crucial for effective hypertension management due to available targeted therapies.

Purpose of the Study:

• To outline the diagnostic and therapeutic strategies for primary hyperaldosteronism.
• To emphasize the importance of screening and confirmatory testing for PHA.
• To differentiate between unilateral adenoma and bilateral hyperplasia and guide treatment decisions.

Main Methods:

• Screening for PHA using the Aldosterone-Renin-Ratio (ARR) in at-risk patients (hypokalemic, severe, resistant, or early-onset hypertension).
• Confirmation of PHA via the saline infusion test.
• Imaging (CT/MRI) and adrenal vein sampling (AVS) to determine the cause (unilateral adenoma vs. bilateral hyperplasia).

Main Results:

• Lateralization of aldosterone production, detected by AVS, indicates a unilateral adenoma, suitable for laparoscopic adrenalectomy with up to 60% cure rate.
• Non-lateralization suggests bilateral hyperplasia, managed pharmacologically with mineralocorticoid receptor antagonists (e.g., Spironolactone, Eplerenone) or potassium-sparing diuretics.
• Additional antihypertensive therapy is often required for complete hypertension control.

Conclusions:

• Accurate diagnosis of PHA through ARR screening, confirmatory tests, and AVS is essential.
• Treatment strategies for PHA vary based on the underlying cause, with surgery for unilateral adenomas and medication for bilateral hyperplasia.
• Timely and appropriate management of PHA can significantly improve patient outcomes and control hypertension.