Primary aldosteronism: An underdiagnosed clinical entity

Abstract

Abstract Primary aldosteronism (PA) is a group of disorders characterized by excessive and autonomous aldosterone secretion by one or both adrenal glands leading to hypertension. Thought to be rare, 5%–13% of the hypertensive patients are found to have PA by systematic screening. There is also a long delay in diagnosis, which may account for high rates of the long-term complications. PA is most commonly caused by bilateral adrenal hyperplasia, followed by an aldosterone-producing adrenal adenoma. Aldosterone-producing adrenal cortical lesions are due to the mutations in various genes encoding membrane-bound ion channels. Some forms of the familial hyperaldosteronism have also been linked to germline mutations. Inappropriate secretion of aldosterone results in hypertension, hypokalemia, and metabolic alkalosis. Hypokalemia is not a must for considering the diagnosis. It is important to detect PA because not only it is a potentially curable cause of hypertension but also patients with PA have a higher prevalence of cardiovascular morbidity and mortality compared with essential hypertension. This article is an account of screening, confirmation, and management strategies of this underdiagnosed clinical entity for the practicing clinicians.