Primary aldosteronism: Progress in diagnosis, therapy, and genetics

Abstract

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and its prevalence increases with the severity of hypertension. The importance of PA diagnosis is not just related to offering a targeted treatment, that is, adrenalectomy, for aldosterone-producing adenoma and medical therapy with mineralocorticoid receptor antagonists for bilateral adrenal hyperplasia, but also because it has been demonstrated extensively that patients affected by PA are more susceptible to cardiovascular events and target organ damage compared to essential hypertensives. Herein, we review the pathophysiology of PA and its clinical features and potential complications; the three step approach employed in the diagnosis of PA, established by the Endocrine Society Guidelines, that is, screening, con fi rmation/exclusion, and subtype diagnosis are discussed; the rarer, familial, and sporadic genetic forms of PA are explained and we conclude with a section on targeted PA therapy.