Primary Aldosteronism

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Abstract

Primary hyperaldosteronism (PA), caused by excess aldosterone secretion from one or both adrenal glands, is the most common form of secondary hypertension and endocrine-related hypertension. Left untreated, patients with PA have worse outcomes compared to matched patients with primary (a.k.a. essential) hypertension. Although consensus treatment guidelines for PA vary, diagnosis is focused on confirming hyperaldosteronism serologically followed by differentiation of unilateral versus bilateral disease with imaging (computerized tomography (CT) or magnetic resonance imaging (MRI)) and adrenal venous sampling. The vast majority of patients with an aldosterone-secreting adenoma can be treated successfully with laparoscopic adrenalectomy with many patients being cured of their hypertension. Factors including age, number of antihypertensive medications, and length of time with diagnosis have been correlated with failure of cure. Moreover, PA patients diagnosed with bilateral adrenal hyperplasia can likewise have improvement in hypertension and downstream cardiovascular outcomes with appropriate mineralocorticoid-receptor antagonist treatment.

Keywords

Primary hyperaldosteronism Endocrine hypertension Secondary hypertension Adrenal venous sampling Familial hyperaldosteronism Adrenalectomy Mineralocorticoid-receptor antagonists 
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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Konstantinos P. Economopoulos
    • 1
  • Carrie C. Lubitz
    • 2
  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of SurgeryHarvard Medical School, Massachusetts General HospitalBostonUSA

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