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 (1–3). In the presence of a high or normal sodium intake, hyperaldosteronism results in sodium and water retention and potassium loss, with ensuing hypertension, hypokalaemia and several detrimental consequences on the cardiovascular system (4–19) that ultimately cause a high rate of atrial fibrillation, ischaemic and haemorrhagic stroke, ‘flash’ pulmonary oedema and myocardial infarction (20,21). An early identification of PA followed by diagnosis of its subtypes is therefore of paramount importance to prevent such complications, particularly in those patients who are curable with surgery (Table 62.1) (20). In fact, when guided by adrenal vein sampling, adrenalectomy can cure hyperaldosteronism in close to 98% of the patients with PA, whereas if surgery is not curative a target drug treatment can avoid the harmful consequences of PA, including damage to target organs (such as the heart, arterial wall, and kidneys) and cardiovascular events. The purpose of this review is to provide updated information on the strategy for identifying patients with PA and for subtype differentiation of PA, and to highlight current treatment modalities.
