Primary Hyperaldosteronism

Excerpt

Primary hyperaldosteronism is an underdiagnosed cause of hypertension. This condition is classically associated with the presence of both hypertension and hypokalemia; however, most patients do not present with hypokalemia in clinical practice. The 2 primary causes of primary hyperaldosteronism are aldosterone-producing adenomas and bilateral adrenal hyperplasia of the zona glomerulosa. Some familial causes have been identified and are classified into types I, II, and III familial hyperaldosteronism.

Diagnosis can be initially confirmed by evaluating the elevated morning aldosterone-to-plasma renin activity ratio. If this ratio exceeds 20:1, it indicates that the adrenal gland is the primary source of excess aldosterone. The preferred treatment for patients with unilateral disease is adrenalectomy. For those who are not candidates for surgery or have bilateral adrenal hyperplasia, medical management with mineralocorticoid antagonists, along with antihypertensive agents, is recommended for additional blood pressure control.