Primary Aldosteronism Questions & Answers

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

What is the relationship between primary aldosteronism and secondary hypertension (HTN)?

How common is secondary hypertension (HTN) due to primary aldosteronism?

What is the importance of a diagnosis of primary aldosteronism?

What is the relationship between primary aldosteronism i and idiopathic adrenal hyperplasia (IAH)?

Why is it important to determine the cause of primary aldosteronism?

What causes primary aldosteronism?

What is the role of aldosterone in primary aldosteronism?

What are the genetic-familial varieties of primary aldosteronism?

What are the screening tests for primary aldosteronism?

Which tests confirm primary aldosteronism?

Which tests are used to determine primary aldosteronism subtype?

What is the initial radiologic study in the workup of primary aldosteronism?

What other tests are used in the workup of primary aldosteronism?

Which medications are used in the treatment of primary aldosteronism?

What is the treatment of choice for lateralized primary aldosteronism?

What is the pathophysiologic association between hypokalemia and primary aldosteronism?

What causes metabolic alkalosis in primary aldosteronism?

How does primary aldosteronism affect glucose tolerance?

What is the main cause of primary aldosteronism syndrome?

What causes glucocorticoid-remediable aldosteronism (GRA)?

How is glucocorticoid-remediable aldosteronism (GRA) in primary aldosteronism treated?

What causes sporadic primary aldosteronism?

What is the role of glucocorticoid-remediable aldosteronism (GRA) in familial primary aldosteronism?

What causes sporadic aldosteronoma in primary aldosteronism?

What is the genetic basis of type 2 familial aldosteronism?

What is the genetic basis of type 3 familial aldosteronism?

What is tertiary aldosteronism?

How is tertiary aldosteronism characterized?

How common is primary aldosteronism in the US?

What is the global prevalence of primary aldosteronism?

Does primary aldosteronism have a racial predilection?

Is primary aldosteronism more common in men or women?

What are the age-related demographics of primary aldosteronism?

What are the morbidity and mortality of primary aldosteronism?

What are the complications of primary aldosteronism?

What is the prognosis of primary aldosteronism?

Presentation

What are the clinical scenarios in which primary aldosteronism should be considered?

What are the symptoms of severe hypokalemia associated with primary aldosteronism?

How are the cardiac effects of primary aldosteronism distinguished from the cardiac effects of secondary aldosteronism?

What are the subtypes of familial primary aldosteronism?

Why is the distinction between type 1 (GRA) and type 2 primary aldosteronism important?

What family history should raise suspicion of primary aldosteronism?

What are the considerations of type 3 familial primary aldosteronism?

What are the initial clinical findings of primary aldosteronism?

What is the role of edema in primary aldosteronism?

DDX

When is a diagnosis of primary aldosteronism indicated?

Which conditions should be considered in the differential diagnosis of primary aldosteronism?

What are the differential diagnoses for Primary Aldosteronism?

Workup

What are the approach considerations in the workup of primary aldosteronism?

What is the role of adrenal phlebography in the workup of primary aldosteronism?

What is the role of a therapeutic trial of spironolactone in the workup of primary aldosteronism?

What is the role of serum potassium and bicarbonate testing in the workup of primary aldosteronism?

What is the role of sodium and magnesium testing in the workup of primary aldosteronism?

What is the role of plasma aldosterone/plasma renin activity ratio testing in the workup of primary aldosteronism?

What are the limitations of the plasma aldosterone/plasma renin activity ratio in the workup of primary aldosteronism?

Which medications interfere with the plasma aldosterone/plasma renin activity ratio in the workup of primary aldosteronism?

What is the role of the plasma aldosterone/plasma renin activity ratio after salt and water depletion and/or upright posture in the workup of primary aldosteronism?

How are the captopril and losartan suppression tests used in the workup of primary aldosteronism?

What is the role of serum aldosterone testing to confirm primary aldosteronism?

What is the role of 24-hour urinary aldosterone (U-Aldo) excretion testing to confirm primary aldosteronism?

How is the salt-loading test used to confirm primary aldosteronism?

How is the subtype of primary aldosteronism determined once a diagnosis has been confirmed?

How is the postural stimulation test used to determine primary aldosteronism subtype?

How are imaging studies used with postural stimulation to identify surgically correctable primary aldosteronism?

What is the postural test protocol for primary aldosteronism?

How is the furosemide (Lasix) stimulation test used in the workup of primary aldosteronism?

What are the indications of the diurnal rhythm of aldosterone in the workup of primary aldosteronism?

What is the initial imaging study in the workup of primary aldosteronism?

How are aldosteronomas characterized on CT scans?

How accurate is CT scanning in the workup of primary aldosteronism?

What are the disadvantages of high-resolution CT studies in the workup of primary aldosteronism?

What is the role of CT scanning in identifying surgical candidates for the treatment of primary aldosteronism?

What is the role of MRI in the workup of primary aldosteronism?

How is the NP-59 test used in the workup of primary aldosteronism?

How accurate is NP-59 testing in the workup of primary aldosteronism?

When is adrenal venous sampling indicated in the workup of primary aldosteronism?

What is the role of adrenal venous sampling in the workup of primary aldosteronism?

How is adrenal venous sampling performed in the workup of primary aldosteronism?

How accurate is adrenal venous sampling in the workup of primary aldosteronism?

What is the diagnostic value of the aldosterone-to-cortisol ratios in the workup of primary aldosteronism?

What are the risks of adrenal venous sampling in the workup of primary aldosteronism?

What is the role of hydroxycorticosterone and oxocortisol-hydroxycortisol assays in the workup of primary aldosteronism?

What is the role of the fludrocortisone suppression test in the workup of primary aldosteronism?

How is the fludrocortisone suppression test performed in the workup of primary aldosteronism?

When is the dexamethasone suppression test indicated in the workup of primary aldosteronism?

How is the dexamethasone suppression test used to diagnose primary aldosteronism?

What is the role of the metoclopramide (Reglan) test in the workup of primary aldosteronism?

How is the metoclopramide (Reglan) test performed in the workup of primary aldosteronism?

What is the role of the corticotropin stimulation test in the workup of primary aldosteronism?

What is the role of the angiotensin-II infusion test in the workup of primary aldosteronism?

How are the histologic findings of primary aldosteronism characterized?

What are the histologic findings of renin-responsive adenomas (RRAs) in primary aldosteronism?

What are the histologic findings of idiopathic adrenal hyperplasia (IAH) in primary aldosteronism?

What are the histologic findings of primary adrenal hyperplasia (PAH) in primary aldosteronism?

What are histologic findings of adrenal carcinoma in the workup of primary aldosteronism?

Treatment

What are the goals of therapy for primary aldosteronism?

How is the appropriate treatment for primary aldosteronism determined?

What is the role of medical therapy in the treatment of aldosteronoma in primary aldosteronism?

Which medications are indicated in the treatment of aldosteronism and heart failure, and how does treatment of primary aldosteronism affect insulin response?

How are calcium channel blockers used to treat primary aldosteronism?

How are mineralocorticoid antagonists used in the treatment of primary aldosteronism?

How are glucocorticoids used to treat primary aldosteronism?

What novel therapies are used to treat primary aldosteronism?

Which nonsurgical treatments are available for adenomas in primary aldosteronism?

What is the treatment of choice for lateralizable primary aldosteronism?

What is the preoperative protocol for adrenal surgery in the treatment of primary aldosteronism?

Which surgical techniques are used to perform adrenalectomy in the treatment of primary aldosteronism?

How effective is adrenalectomy in the treatment of hypertension associated with primary aldosteronism?

Is adrenalectomy an effective treatment for idiopathic adrenal hyperplasia (IAH) associated with primary aldosteronism?

What are the indications of persistent hypertension (HTN) after adrenal surgery in the treatment of primary aldosteronism, and what is the affect of adrenalectomy on the incidence of atrial fibrillation?

What is the preoperative care for patients undergoing adrenal surgery to treat primary aldosteronism?

What is the postoperative care for patients undergoing adrenal surgery to treat primary aldosteronism?

What is the treatment for hypoaldosteronism after adrenal surgery to treat primary aldosteronism?

How does dietary salt affect biochemical testing results in primary aldosteronism?

Guidelines

What are the French recommendations on the management of primary aldosteronism?

What are the Endocrine Society practice guidelines for the diagnosis and treatment of primary aldosteronism?

Medications

What is the treatment of choice in nonsurgical primary aldosteronism?

How is glucocorticoid-remediable aldosteronism (GRA) treated in primary aldosteronism?

Which antihypertensives are used to treat primary aldosteronism?

What other factors contribute to the success of pharmacologic treatment of primary aldosteronism?

Which medications in the drug class Corticosteroids are used in the treatment of Primary Aldosteronism?

Which medications in the drug class Angiotensin II Receptor Blockers are used in the treatment of Primary Aldosteronism?

Which medications in the drug class ACE Inhibitors are used in the treatment of Primary Aldosteronism?

Which medications in the drug class Calcium channel Blockers are used in the treatment of Primary Aldosteronism?

Which medications in the drug class Thiazide Diuretics are used in the treatment of Primary Aldosteronism?

Which medications in the drug class Potassium-Sparing Diuretics are used in the treatment of Primary Aldosteronism?

Which medications in the drug class Aldosterone Antagonists, Selective are used in the treatment of Primary Aldosteronism?