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?
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?
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?
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?
What is the postural test protocol for primary aldosteronism?
How is the furosemide (Lasix) stimulation test used 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 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 are the risks of adrenal venous sampling 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?
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?
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?
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?
-
Magnetic resonance imaging (MRI) scan in a patient with Conn syndrome showing a left adrenal adenoma.
-
Scintigram obtained by using iodine-131-beta-iodomethyl-norcholesterol (NP-59) in a 59-year-old man with hypertension shows fairly intense radionuclide uptake in the right adrenal tumor. At surgery, a Conn tumor was confirmed.
-
Effects of main antihypertensives on the renin-angiotensin system.
-
Potential causes of primary aldosteronism.
-
Transitional zone adrenocortical steroids.
-
Algorithm for screening for potential primary aldosteronism.
-
Algorithm for confirmation of primary aldosteronism.
-
Algorithm for distinguishing subtypes of primary aldosteronism.
Tables
What would you like to print?
- Overview
- Presentation
- DDx
- Workup
- Approach Considerations
- Screening (First-Tier) Tests
- Confirmatory (Second-Tier) Tests
- Determination of Primary Aldosteronism Subtype (Third-Tier) Tests
- CT Scanning and MRI
- NP-59 Iodo-methyl-norcholesterol Scintigraphy
- Adrenal Venous Sampling
- Hydroxycorticosterone and Oxocortisol-Hydroxycortisol Assays
- Fludrocortisone Suppression Test
- Dexamethasone Suppression Test
- Metoclopramide (Reglan) Test
- Additional Laboratory Studies
- Angiotensin-II infusion test
- Histological Findings
- Show All
- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References