Primary aldosteronism: an update on screening, diagnosis and treatment.
BACKGROUND
Primary aldosteronism is much more common than previously held; it implies an excessive organ damage to the heart, vessels and kidney, which translates into an excess of cardiovascular events. These two features, along with the fact that the arterial hypertension and the hypokalemia can be corrected with a timely diagnosis and an appropriate therapy, warrant an aggressive diagnostic approach in hypertensive patients.


OBJECTIVE
To provide updated information on the screening and exclusion tests for primary aldosteronism and to illustrate the strategy that can be followed for primary aldosteronism subtype differentiation.


METHODS
Review of the literature and personal experience of the authors.


RESULTS
The available evidence showed that a cost-effective strategy for the screening of patients with primary aldosteronism can be exploited at most centres. At variance, the identification of primary aldosteronism subtypes, for example, the differentiation of patients with an aldosterone-producing adenoma from those with idiopathic hyperaldosteronism should be undertaken at tertiary referral centres.


CONCLUSIONS
The identification of a curable form of primary aldosteronism can be much rewarding for the patient and the doctor. Thus, an aggressive diagnostic approach is mandatory at least in some subgroups of hypertensive patients who are at higher prior risk of primary aldosteronism or can benefit more from an accurate diagnosis.
Rossi
Gian Paolo
GP
DMCS, Clinica Medica 4, Policlinico Universitario, Padova, Italy. gianpaolo.rossi@unipd.it
Pessina
Achille Cesare
AC
Heagerty
Anthony M
AM
D003937:Diagnosis, Differential; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008403:Mass Screening; D015995:Prevalence