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Published on: September 15, 2017
Primary aldosteronism
Anand Vaidya1, Gregory A Kline2, Paolo Mulatero3
1Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Metabolism, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
Nature Reviews. Disease Primers
|June 25, 2026
Summary
Primary aldosteronism (PA), caused by excess aldosterone, is a common hypertension cause. Early diagnosis and tailored treatment, including surgery or medication, are crucial for managing cardiovascular and renal risks.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Nephrology
Background:
- Primary aldosteronism (PA) stems from excessive aldosterone production, a significant contributor to hypertension and associated cardiovascular/renal damage.
- Genetic mutations and aberrant receptor expression in adrenal glands drive dysregulated aldosterone synthesis.
- PA is frequently underdiagnosed, necessitating improved screening protocols in hypertensive individuals.
Purpose of the Study:
- To review the causes, diagnosis, and management strategies for primary aldosteronism.
- To highlight the importance of early detection and appropriate therapeutic interventions.
Main Methods:
- Literature review of primary aldosteronism research, focusing on pathophysiology, diagnostic approaches, and treatment modalities.
- Analysis of current guidelines and emerging therapies.
Main Results:
- PA is driven by genetic factors and receptor dysregulation, leading to hypertension and end-organ damage.
- Simplified renin and aldosterone testing is recommended for all hypertensive patients.
- Unilateral PA may be treated surgically, while bilateral PA requires medical management.
- Emerging biomarkers and imaging aid in treatment decisions.
Conclusions:
- Timely diagnosis and management of PA are essential to mitigate cardiovascular and renal morbidity.
- Medical therapy aims to normalize blood pressure and potassium levels, with renin rise indicating adequate treatment.
- Longitudinal monitoring is vital for managing PA, its complications, and treatment effects.
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