Summary

• Most common specifically treatable and potentially curable form of HTN, accounting for at least 5% of hypertensive patients, with most patients being normokalaemic.
• Approximately 30% have unilateral forms correctable by unilateral laparoscopic adrenalectomy, and 70% have bilateral forms in which HTN responds well to aldosterone antagonist medicines.
• Optimal detection involves screening all hypertensive patients using the plasma aldosterone/renin ratio, after controlling for factors (including medicines) that may confound results.
• In patients with repeatedly elevated aldosterone/renin ratios, definitive confirmation or exclusion of diagnosis involves careful suppression testing with measurement of aldosterone response to fludrocortisone or to salt loading.
• Subtype differentiation for optimal treatment involves genetic testing for the hybrid gene causing familial hyperaldosteronism type I (glucocorticoid-remediable aldosteronism). A negative genetic test should be followed by adrenal CT and adrenal venous sampling to differentiate unilateral from bilateral forms.