Who needs to be screened for primary aldosteronism?

Area of Science:

• Endocrinology
• Cardiology
• Nephrology

Background:

• Primary aldosteronism (PA) affects 5%-15% of hypertensive patients, often as secondary hypertension.
• Key causes include bilateral adrenal hyperplasia and aldosterone-producing adenoma.
• Diagnosis involves screening, confirmatory testing, and subtype differentiation.

Purpose of the Study:

• To identify specific patient groups who should be screened for primary aldosteronism.
• To expand screening recommendations beyond established guidelines for potential PA cases.

Main Methods:

• Review of established guidelines for PA screening.
• Identification of additional patient profiles at increased risk for PA.
• Consideration of cost-effectiveness in screening recommendations.

Main Results:

• Recommended screening for resistant/persistent hypertension, hypokalemia, young hypertensive patients (<40 years), and those with a family history of PA.
• Suggested screening for hypertensive patients with early target organ damage, adrenal incidentaloma, obstructive sleep apnea, atrial fibrillation, anxiety, and psychosomatic symptoms.

Conclusions:

• Expanded screening criteria for primary aldosteronism can improve early detection.
• Targeted screening in at-risk hypertensive populations is essential for clinical practice.
• Consideration of comorbidities and cost-effectiveness aids in optimizing screening strategies.