ABSTRACT
While most patients with hypertension have no underlying cause and require lifelong medications, 5–10% have the treatable condition of primary aldosteronism. In primary aldosteronism, the adrenal glands overproduce the hormone aldosterone, leading to salt retention, hypertension, and occasionally hypokalemia. Patients with primary aldosteronism are more likely to have resistant hypertension and are at higher risk of developing cardiovascular disease and death. Hence, patients with hypertension should be screened for this condition with a blood test for aldosterone–renin ratio.
While primary aldosteronism can be treated with lifelong aldosterone antagonists, those with unilateral adrenal disease (∼50%) can be offered curative unilateral adrenalectomy. This cures hypokalemia if present and improves or cures hypertension. Recent studies have shown that surgery leads to better outcomes compared to long-term medications and further stresses the importance of identifying these patients. Adrenal vein sampling is important to identify unilateral disease. However, it is invasive, technically difficult, and may occasionally yield inconclusive results. Hence, this remains a barrier to identify patients with unilateral primary aldosteronism, a curable form of hypertension. In the future, functional imaging (such as 11C-metomidate PET–CT imaging) may offer a convenient and accurate noninvasive alternative to identifying these patients.
