Abstract
Primary aldosteronism is the most common cause of secondary hypertension. In the past, screening for primary aldosteronism was offered only in patients with hypertension associated with hypokalemia. Recent studies showed that hypokalemia is seen in only 25% of the patients with primary aldosteronism, which has increased the prevalence of primary aldosteronism to 10–15% of all cases with new onset hypertension.
Highlights
85 million people in the United States are estimated to be hypertensive
In one study, seated plasma aldosterone levels were less than 15 ng/d in 36% of 74 patients diagnosed with primary aldosteronism (PA) after screening positive by ARR defined as more than 30 and showing failure of aldosterone to suppress during fludrocortisone suppression testing (FST) and in four of 21 patients found by adrenal venous sampling (AVS) to have unilateral, surgically correctable PA
Aldosterone suppression testing can be performed with orally administered sodium chloride and measurement of urinary aldosterone or with intravenous sodium chloride loading and measurement of plasma aldosterone concentration (PAC)
Summary
85 million people in the United States are estimated to be hypertensive. The hypertension is “essential” or “idiopathic,” but a subgroup of approximately 15% has secondary hypertension. The secondary causes of hypertension can be divided into renal (e.g., renovascular or renal parenchymal disease) and endocrine causes. There are at least 14 endocrine disorders in which hypertension may be the initial clinical presentation (Table 1). A further classification of the adrenocortical causes of hypertension based on the levels of renin and aldosterone can be used for the diagnostic approach of a patient with suspected endocrine hypertension (Table 2). An accurate diagnosis of endocrine hypertension provides the clinician with a unique treatment opportunity, that is, to render a surgical cure or to achieve a dramatic response with pharmacologic therapy. Primary hyperaldosteronism, which represents the most common cause of endocrine resistant hypertension, is reviewed here
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