Key Points
2
Î Primary aldosteronism (PA) is a group of disorders in which
aldosterone production is inappropriately high for sodium status,
relatively autonomous of the major regulators of secretion (angiotensin
II, plasma potassium concentration), and nonsuppressible by sodium
loading.
Î Such inappropriate production of aldosterone causes hypertension,
cardiovascular damage, sodium retention, suppression of plasma
renin, and increased potassium excretion that (if prolonged and
severe) may lead to hypokalemia.
• Only 9–37% of patients with PA have hypokalemia.
Î PA is commonly caused by an adrenal adenoma, unilateral or bilateral
adrenal hyperplasia (BAH), or in rare cases adrenal carcinoma or
inherited conditions of familial hyperaldosteronism.
Î Cross-sectional and prospective studies report PA in >5% and
possibly >10% of hypertensive patients, both in general and in
specialty settings.
Î Patients with PA have higher cardiovascular morbidity and mortality
than age- and sex-matched patients with essential hypertension and
the same degree of BP elevation.
Î Specific treatments, either by mineralocorticoid receptor (MR)
antagonists or unilateral adrenalectomy, are available that ameliorate
the impact of this condition on important patient outcomes.