Primary aldosteronism
Summary
Definition
History and exam
Key diagnostic factors
- hypertension
- presence of risk factors
Other diagnostic factors
- age 20 to 70 years
- nocturia, polyuria
- lethargy
- mood disturbance (irritability, anxiety, depression)
- difficulty concentrating
- paraesthesias, muscle cramps
- muscle weakness
- palpitations
Risk factors
- family history of PA
- family history of early onset of hypertension and/or stroke
Diagnostic investigations
1st investigations to order
- plasma potassium
- aldosterone/renin ratio
Investigations to consider
- oral salt loading test
- saline infusion testing
- genetic testing
- adrenal CT
- adrenal venous sampling
- adrenal MRI
- posture stimulation testing
- angiotensin II infusion testing
- 24-hour urinary hybrid steroids (18-hydroxy- and 18-oxo-cortisol)
- dexamethasone suppression testing
Emerging tests
- ¹¹ C-Metomidate PET/CT
Treatment algorithm
unilateral PA
bilateral PA (excluding familial hyperaldosteronism type I)
familial hyperaldosteronism type I
Contributors
Authors
Michael Stowasser, MBBS, FRACP, PhD
Professor
Endocrine Hypertension Research Centre
University of Queensland Frazer Institute
Greenslopes and Princess Alexandra Hospitals
Brisbane
Queensland
Australia
Disclosures
MS is an author of several references cited in this topic.
Acknowledgements
Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this topic.
Peer reviewers
Paolo Mulatero, MD
Department of Medicine and Experimental Oncology
Division of Medicine and Hypertension
San Giovanni Battista Hospital
Torino
Italy
Divulgaciones
PM declares that he has no competing interests.
Wail Malaty, MD
Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
Assistant Program Director
MAHEC Rural Family Medicine Residency
Hendersonville
NC
Divulgaciones
WM declares that he has no competing interests.
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Referencias
Artículos principales
Mulatero P, Sechi LA, Williams TA, et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020 Oct;38(10):1929-36. Resumen
Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92. Resumen
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 May;101(5):1889-916.Texto completo Resumen
Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Essential hypertension (HTN)
- Thiazide-induced hypokalaemia in patient with essential HTN
- Renal artery stenosis
Más DiferencialesGuías de práctica clínica
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021
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