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Primary Aldosteronism: Diagnosis and Management.

Geeta Gyamlani1, Carol M Headley2, Adnan Naseer1

  • 1Nephrology Section, Veterans Affairs Medical Center, Memphis, Tennessee; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.

The American Journal of the Medical Sciences
|October 26, 2016
PubMed
Summary

Primary aldosteronism, a common cause of secondary hypertension, involves adrenal gland issues. Treatment depends on unilateral or bilateral disease, with surgery for unilateral cases and medication for bilateral or non-surgical candidates.

Keywords:
DiagnosisHypertensionOutcomePrimary aldosteronismTreatment

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Area of Science:

  • Endocrinology
  • Nephrology
  • Cardiovascular Medicine

Background:

  • Primary aldosteronism (PA) is a frequent yet often overlooked cause of secondary hypertension.
  • PA results from idiopathic hyperaldosteronism (bilateral adrenal involvement) or aldosterone-producing adenomas (unilateral involvement).

Purpose of the Study:

  • To outline the diagnostic and treatment strategies for primary aldosteronism.
  • To differentiate management approaches based on unilateral versus bilateral adrenal gland involvement.

Main Methods:

  • Initial diagnosis involves assessing the plasma aldosterone to renin ratio.
  • Imaging techniques like CT or MRI are used for localization.
  • Adrenal vein sampling confirms the extent of adrenal gland involvement.

Main Results:

  • Adrenalectomy offers a high likelihood of biochemical cure for unilateral PA in surgical candidates.
  • Blood pressure improvement post-adrenalectomy occurs in 30-50% of patients.
  • Mineralocorticoid antagonists are the primary treatment for bilateral PA or non-surgical candidates.

Conclusions:

  • Accurate diagnosis and localization are crucial for effective primary aldosteronism management.
  • Treatment decisions for PA should be tailored to the specific adrenal gland involvement and patient candidacy for surgery.
  • While surgery can resolve biochemical abnormalities, significant blood pressure improvement varies in patients with unilateral PA.