Primary aldosteronism: emerging trends

• Primary aldosteronism is the most common cause of endocrine hypertension.
• Recent epidemiologic studies demonstrate a higher prevalence than previously estimated.
• Although imperfect, the aldosterone:renin ratio is the preferred screening test.
• Diagnosis with patient-centered treatment improves outcomes.

Primary aldosteronism (PA) is the most common etiology of endocrine hypertension (HTN), and recent prevalence studies suggest that it may be under-diagnosed. Indications for screening have been expanded with recognition that many patients with PA do not have hypokalemia and that the disease may be familial. The aldosterone:renin ratio (ARR) is the preferred screening test for PA. The ARR can be interpreted in patients on most anti-hypertensive agents, and can be used to guide medical therapy of HTN even in patients without PA. Once PA is confirmed, adrenal venous sampling (AVS) should be performed to determine if PA is due to bilateral disease or a unilateral adenoma, if surgery is being considered. Targeted medical or surgical therapy improves patient outcomes.