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
- aldosterone/renin ratio
- plasma potassium test
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
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
NC
Declarações
WM declares that he has no competing interests.
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Referências
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: an Endocrine Society clinical practice guideline. 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 hypokalaemia in patient with essential HTN
- Renal artery stenosis
Mais Diagnósticos diferenciaisDiretrizes
- 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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