Screening for Surgically Correctable Hypertension Caused by Primary Aldosteronism

Abstract

Hypertension and hypokalemia related to excessive aldosterone secretion by an adrenal adenoma was first described by Jerome Conn in 1955. 1 Since that time, four subgroups of patients with primary aldosteronism have been characterized, including those with aldosteroneproducing adenoma (APA), idiopathic hyperaldosteronism (IHA), glucocorticoid remediable hyperaldosteronism, and indeterminant hyperaldosteronism. 2-4 Of these causes of primary aldosteronism, APA accounts for approximately 60% and IHA for about 40%, and the other two disorders are rare. Only patients with APA predictably respond to a specific surgical approach with normalization of blood pressure, 5 so that identification of primary aldosteronism and differentiation from the other forms of the disease have important clinical relevance. Nevertheless, a convenient, economical, and reliable diagnostic screening test for surgically correctable primary aldosteronism heretofore has not been available; and patients suspected as having surgically remediable hypertension caused by primary aldosteronism have had to be admitted to the hospital for a