Diagnosis and treatment of primary aldosteronism

Abstract

Primary aldosteronism is the most common form of secondary hypertension. We got more information about this disease in recent years. We could use aldosterone to renin ratio (ARR) above 30 ng/dL per ng/ml/hour as screening test and confirmatory tests (oral sodium loading test, intravenous saline infusion test, fludrocortisone suppression test or Captopril test) in diagnosis, and we could also differentially diagnose the two major subtypes of primary aldosteronism, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) by high resolution computed tomography (HRCT) and even adrenal vein sampling. APA could be cured by adrenalectomy, but BAH was treated medically. In hypertensive management, by reviewing of the diagnosis and treatment of primary aldosteronism in this literature, clinicians should pay much more attention to and find possible occult primary aldosteronism and thus aggressive surgical intervention or medical treatment is indicated.