Resumo
Definition
History and exam
Key diagnostic factors
- hypertension
Other diagnostic factors
- age 20 to 70 years
- nocturia, polyuria
- lethargy
- mood disturbance (irritability, anxiety, depression)
- difficulty concentrating
- paresthesias, muscle cramps
- muscle weakness
- palpitations
Risk factors
- family history of PA
- family history of early onset of hypertension and/or stroke
Diagnostic tests
1st tests to order
- plasma potassium
- aldosterone/renin ratio
Tests 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
Disclosures
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
Disclosures
WM declares that he has no competing interests.
References
Key articles
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. Abstract
Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92. Abstract
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.Full text Abstract
Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Essential hypertension (HTN)
- Thiazide-induced hypokalemia in patient with essential HTN
- Renal artery stenosis
More DifferentialsGuidelines
- 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
More Guidelines
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