title: Primary aldosteronism: current knowledge and controversies in Conn's syndrome.
abstract: Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of the hypertensive population. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass. The most advocated screening test at present is the aldosterone-to-renin ratio, which has a high sensitivity but low specificity. The specificity increases if patients with low aldosterone concentrations are excluded. Published cut-off values vary depending on the hormone assay and the investigated population. Before screening, antihypertensive treatment, especially aldosterone antagonists and beta-blockers, should be discontinued. A pathologic result requires additional work up to prove mineralocorticoid excess. Subtype differentiation is performed by adrenal venous sampling combined with imaging (CT or MRI). One-third of cases are due to aldosterone-producing adenomas, for which the preferred treatment is laparoscopic adrenalectomy. Bilateral adrenal hyperplasia (idiopathic aldosteronism) underlies two-thirds of cases and requires treatment with aldosterone antagonists. Treatment is started with low doses of spironolactone (25-50 mg once daily), which often results in substantial improvements in hypertension.
authors.affiliation: Medizinische Klinik Innenstadt, University Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Schirpenbach
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000465:Algorithms; D006801:Humans; D006929:Hyperaldosteronism / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence