Diagnosis and management of primary aldosteronism

Primary aldosteronism (PA), the most common form of secondary hypertension, can either be surgically cured or treated with targeted pharmacotherapy. If left untreated, PA has associated cardiovascular morbidity and nephrotoxicity. Thus, clinicians should consider PA in all patients with hypertension and perform case detection testing in those who are at high risk for PA. Confirmatory testing is indicated in most patients who have positive case detection testing. The next step is to determine if patients with confirmed PA have disease that can be cured with surgery or if it should be treated medically—this step is guided by CT scan of the adrenal glands and adrenal vein sampling.