Primary aldosteronism

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Última revisão: 20 Aug 2025

Última atualização: 09 May 2025

Primary aldosteronism (PA) is the most common specifically treatable and potentially curable form of hypertension. It accounts for at least 5% of hypertensive patients, with most patients normokalemic.

Approximately 30% have unilateral forms correctable by unilateral laparoscopic adrenalectomy, and 70% have bilateral forms in which hypertension responds well to aldosterone antagonist medications.

Optimal detection involves screening all hypertensive patients using the plasma aldosterone/renin ratio, after controlling for factors (including medications) that may confound results.

In patients with repeatedly elevated aldosterone/renin ratios, definitive confirmation or exclusion of diagnosis is required.

Subtype differentiation for optimal treatment involves genetic testing for familial forms where suspected. If genetic testing is not performed or negative, adrenal CT and adrenal venous sampling should be performed to differentiate unilateral from bilateral forms.

Definição

In PA, aldosterone production exceeds the body's requirements and is relatively autonomous with regard to its normal chronic regulator, the renin-angiotensin II system.[1][2] This results in excessive sodium reabsorption via amiloride-sensitive epithelial sodium channels within the distal nephron, leading to hypertension and suppression of renin-angiotensin II. Urinary loss of potassium and hydrogen ions, exchanged for sodium at the distal nephron, may result in hypokalemia and metabolic alkalosis if severe and prolonged.[1][2]

História e exame físico

Principais fatores diagnósticos

hypertension

Detalhes completos

Outros fatores diagnósticos

age 20 to 70 years
nocturia, polyuria
lethargy
mood disturbance (irritability, anxiety, depression)
difficulty concentrating
paresthesias, muscle cramps
muscle weakness
palpitations

Detalhes completos

Fatores de risco

family history of PA
family history of early onset of hypertension and/or stroke

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

plasma potassium
aldosterone/renin ratio

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Novos exames

¹¹ C-Metomidate PET/CT

Algoritmo de tratamento

CONTÍNUA

unilateral PA

bilateral PA (excluding familial hyperaldosteronism type I)

familial hyperaldosteronism type I

Colaboradores

Autores

Michael Stowasser, MBBS, FRACP, PhD

Professor

Endocrine Hypertension Research Centre

University of Queensland Frazer Institute

Greenslopes and Princess Alexandra Hospitals

Brisbane

Queensland

Australia

Declarações

MS is an author of several references cited in this topic.

Agradecimentos

Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this topic.

Revisores

Paolo Mulatero, MD

Department of Medicine and Experimental Oncology

Division of Medicine and Hypertension

San Giovanni Battista Hospital

Torino

Italy

Declarações

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

Declarações

WM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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. Resumo

Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92. Resumo

Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment. J Clin Endocrinol Metab. 2016 May;101(5):1889-916.Texto completo Resumo

Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Essential hypertension (HTN)
- Thiazide-induced hypokalemia in patient with essential HTN
- Renal artery stenosis
Mais Diagnósticos diferenciais
Diretrizes
- 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
Mais Diretrizes
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Primary aldosteronism

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

unilateral PA

bilateral PA (excluding familial hyperaldosteronism type I)

familial hyperaldosteronism type I

Colaboradores

Autores

Michael Stowasser, MBBS, FRACP, PhD

Declarações

Agradecimentos

Revisores

Paolo Mulatero, MD

Declarações

Wail Malaty, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

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