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Published on: September 15, 2017
Primary Hyperaldosteronism: Approach to Diagnosis and Management
Nadine El-Asmar1, Aman Rajpal2, Baha M Arafah1
1Division of Clinical and Molecular Endocrinology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA.
Insights
Hyperaldosteronism is more common than previously thought and increases cardiovascular risk. Early screening, diagnosis, and treatment with mineralocorticoid receptor antagonists or surgery can effectively manage the condition.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Hyperaldosteronism is increasingly recognized as a prevalent endocrine disorder.
- Patients with hyperaldosteronism face a significantly elevated risk of cardiovascular events.
- Prompt diagnosis and management are crucial for mitigating patient risk.
Purpose of the Study:
- To review the diagnostic approaches for hyperaldosteronism.
- To discuss current therapeutic strategies, including medical and surgical options.
- To evaluate the long-term outcomes associated with different treatment modalities.
Main Methods:
- Initial biochemical screening for hyperaldosteronism.
- Confirmatory diagnostic testing to establish biochemical diagnosis.
- Utilizing adrenal imaging (CT/MRI) and adrenal vein sampling for subtype determination and lateralization.
- Assessing treatment efficacy through symptom control and plasma renin activity normalization.
Main Results:
- Hyperaldosteronism is more common than previously estimated.
- Cardiovascular event risk is substantially higher in affected patients.
- Both surgical intervention and optimal medical management with mineralocorticoid receptor antagonists yield similar long-term outcomes.
- Treatment effectively controls symptoms and normalizes key biochemical markers.
Conclusions:
- Hyperaldosteronism requires increased clinical recognition due to its prevalence and associated cardiovascular risks.
- A systematic diagnostic pathway involving screening, confirmation, and lateralization is essential.
- Effective management can be achieved through either surgical or medical therapy, with comparable long-term results.
Abstract:
Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. Patients suspected of having hyperaldosteronism should undergo initial screening and subsequent confirmatory testing to establish a biochemical diagnosis. Although adrenal computed tomography/magnetic resonance imaging scans often define a disease's subtype, adrenal vein sampling, in order to determine lateralization, may be necessary in some patients who are surgical candidates. Medical therapy using optimal doses of mineralocorticoid receptor antagonists can control symptoms and normalize plasma renin activity. The long-term outcome of patients treated with either surgical or optimal medical therapy appears similar.
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