Primary aldosteronism.

BACKGROUND: Hypertension is one of the world's leading risk factors for morbidity and mortality. Most affected individuals have primary hypertension, while the most common cause of secondary hypertension is primary aldosteronism (6-10%). PRIMARY ALDOSTERONISM: Clinical manifestations include hypertension, hypokalemic alkalosis, renal dysfunction, nephrogenic diabetes insipidus, muscle weakness, paresthesias, tetany and, in severe cases, paralysis. The cardiovascular risks for patients with primary aldosteronism are greater than those for patients with primary hypertension. Compared with normotensive subjects, patients with primary aldosteronism have a 4.2-fold greater risk of stroke, a 6.5-fold greater risk of myocardial infarction and a 12.1-fold greater risk of atrial fibrillation.

DIAGNOSIS: Patients with hypertension are screened for primary aldosteronism based on the plasma aldosterone to plasma renin activity ratio. A value >30 constitutes a positive result. The diagnosis must be confirmed using one of four available aldosterone suppression tests. Lateralization of aldosterone hypersecretion is documented by adrenal venous sampling.

MANAGEMENT: The foundation of primary aldosteronism management is normalization of circulating aldosterone and/or mineralocorticoid blockade. Optimal treatment of unilateral disease is adrenalectomy; spironolactone is the treatment of choice for bilateral disease.