Primary hyperaldosteronism

Ann Clin Biochem 2003;40:439-452
© 2003 Association for Clinical Biochemistry

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Review Articles

Sunil Nadar,
Gregory YH Lip and
D Gareth Beevers

University Department of Medicine, City Hospital, Birmingham B18 7QH, UK;
University Department of Medicine, City Hospital, Birmingham B18 7QH, UK;
University Department of Medicine, City Hospital, Birmingham B18 7QH, UK

Primary hyperaldosteronism is an important cause of hypertension.Its true prevalence is still a matter of debate, since about10% of hypertensives may have underlying hyperaldosteronism.Primary hyperaldosteronism is due to aldosterone-secreting tumours,bilateral adrenal hyperplasia or, rarely, adrenal carcinomaor genetic causes.

There is considerable debate over the optimal screening methodsfor detecting hyperaldosteronism. The patients who benefit themost from screening are young hypertensives, those with resistanthypertension and patients with serum potassium of less than3.5 mmol/L, especially in the presence of a high sodium. Varioustests are available for screening patients with hypertensionfor hyperaldosteronism. Serum potassium is an unreliable markerfor hyperaldosteronism, although a low value in a patient nottaking diuretics should make one suspect the diagnosis. Theuse of serum potassium as a screening test would miss abouta third of cases. Determination of the ratio of plasma aldosteroneconcentration to plasma renin activity is widely accepted asthe test of choice for screening. Tests such as diurnal variationsin aldosterone concentration and response to angiotensin IIhelp to demonstrate the autonomy of the aldosterone secretion.

Once the diagnosis of hyperaldosteronism is made, further testssuch as magnetic resonance imaging or computed tomographic scanningand adrenal vein sampling should be undertaken to determinethe aetiology of the hyperaldosteronism. Depending on the findingsand the lateralization of the lesion, either surgery or medicaltherapy may be advised for the patient. Spironolactone wouldbe the drug of choice for medical treatment. Laparoscopic adrenalectomyhas become a widely employed method of surgically removing adrenaltumours.

Hyperaldosteronism represents one of the few treatable causesof hypertension and a systematic approach is therefore neededto ensure that the few patients with an aldosterone-secretingadrenal adenoma are identified. It is important to identifythese patients so that only those patients with proven adenomasare referred for adrenalectomy.

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