Diagnosis and treatment of primary hyperaldosteronism: Review

Primary hyperaldosteronism is the syndrome of excessive aldosterone secretion and concomitant suppression of the angiotensin-renin system. Its main pathophysiological features are hypertension, altered potassium homeostasis and accelerated target organ damage. Prospective studies on its prevalence around the world reveal that primary hyperaldosteronism occurs in 5-15% of patients with essential hypertension. The major causes of primary hyperaldosteronism are aldosterone-producing adenoma and bilateral idiopathic adrenal hyperplasia. Patients with hypertension and hypokalemia and most patients with treatment-resistant hypertension should be screened for primary aldosteronism with the calculation of plasma concentration to plasma renin activity ratio. The diagnosis is generally 3-tiered, involving an initial screening, confirmation of diagnosis, and determination of the specific subtype of primary hyperaldosteronism. Primary hyperaldosteronism is often refractory to conventional medical treatment. Unilateral laparoscopic adrenalectomy is an excellent treatment option for patients with unliateral aldosterone-producing-adenoma. But bilateral idiopathic hyperaldosteronism should be treated medically. Sprinolactone has been the drug of choice to treat primary hyperaldosteronism for more than three decades. The treatment goal is to prevent morbidity and mortality associated with hypertension, hypokalemia and cardiovascular damage.