Summary
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 investigations
1st investigations to order
- plasma potassium
- aldosterone/renin ratio
Investigations to consider
- fludrocortisone suppression test
- saline infusion testing
- oral salt loading
- genetic testing
- adrenal CT
- adrenal venous sampling
- adrenal MRI
- adrenal selenocholesterol scanning
- 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 School of Medicine
Greenslopes and Princess Alexandra Hospitals
Brisbane
Queensland
Australia
Disclosures
MS is an author of references cited in this monograph.
Acknowledgements
Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this monograph.
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.
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
- The management of primary aldosteronism: case detection, diagnosis, and treatment
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