PRIMARY HYPERALDOSTERONISM

Course overview

PRIMARY HYPERALDOSTERONISM (PA) IS AN UNDERDIAGNOSED CAUSE OF HYPERTENSION. THE CLASSIC PRESENTATION OF PA INCLUDES HYPERTENSION AND HYPOKALEMIA. HOWEVER, IN REALITY, MOST PATIENTS WILL PRESENT WITHOUT HYPOKALEMIA. THE TWO PRIMARY CAUSES ARE ALDOSTERONE-PRODUCING ADENOMAS AND BILATERAL ADRENAL HYPERPLASIA OF THE ZONA GLOMERULOSA. FAMILIAL CASES HAVE BEEN FOUND AND ARE CLASSIFIED INTO TYPE I, TYPE II, AND TYPE III FAMILIAL HYPERALDOSTERONISM. DIAGNOSIS CAN INITIALLY BE CONFIRMED WITH THE ELEVATED MORNING ALDOSTERONE TO PLASMA RENIN ACTIVITY RATIO. IF THE RATIO IS HIGHER THAN 20 TO 1, THEN THE EXCESS ALDOSTERONE POINTS TO THE ADRENAL GLAND AS THE PRIMARY SOURCE. THE PREFERRED TREATMENT IS ADRENALECTOMY IN THOSE WITH UNILATERAL DISEASE. THOSE WHO ARE POOR SURGICAL CANDIDATES OR HAVE BILATERAL ADRENAL HYPERPLASIA CAN BE TREATED MEDICALLY WITH MINERALOCORTICOID ANTAGONISTS AS WELL AS ANTIHYPERTENSIVE AGENTS FOR FURTHER BLOOD PRESSURE CONTROL. THIS ACTIVITY REVIEWS THE EVALUATION AND MANAGEMENT OF PRIMARY HYPERALDOSTERONISM AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN IDENTIFYING AND TREATING THIS CONDITION.