ABSTRACT
Primary aldosteronism (PA), a common, albeit markedly underdiagnosed cause of curable arterial hypertension, is characterized by plasma levels of aldosterone that are inappropriate for the salt/volume/ and blood pressure status and concur with low measurable levels of plasma renin. The demonstration of an inappropriate secretion of aldosterone that is autonomous from the renin–angiotensin system is the first step for diagnosing PA. Some clinicians prefer the measurement of urinary aldosterone because they hold it to provide an estimate of aldosterone production integrated over 24 hours. Given the fallacies of the imaging tests, AVS remains the key technique for diagnosing unilateral production of aldosterone, but it is expensive, technically demanding, and carries a very small, but not negligible, risk of adrenal vein rupture. Experimental studies have shown that aldosterone secretion persists even during prominent sodium loading and studies using in situ hybridization and immunohistochemistry have shown persistent aldosterone synthesis in the adrenal cortex surrounding an Aldosterone-Producing Adenoma.
