Diagnosis and management of primary aldosteronism.
OBJECTIVE
To illustrate the steps for clinical management of primary aldosteronism from screening evaluation to surgical and/or medical treatment.


RESULTS
It is now widely accepted that primary aldosteronism represents the most common form of endocrine hypertension and its early diagnosis is crucial for hypertensive patients who can be cured by the surgical removal of an aldosterone-secreting adenoma or benefit from a specific medical treatment with mineralocorticoid receptor antagonists. Recent evidence indicates that hyperaldosteronism is indeed associated with detrimental consequences on cardiovascular system, renal function and glucose metabolism.


CONCLUSIONS
The diagnostic protocol for primary aldosteronism requires multistep evaluation and should begin with a screening test, followed when appropriate, by confirmatory test and functional and anatomical evaluation. Finally, although it is technically difficult and the cut-off levels for acceptance of the success are not standardized, the subtype forms should be identified using a selective adrenal venous sampling.
Boscaro
Marco
M
Division of Endocrinology, Universitá Politecnica delle Marche, Ancona, Italy. m.boscaro@univpm.it
Ronconi
Vanessa
V
Turchi
Federica
F
Giacchetti
Gilberta
G
D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000601:surgery; D000311:Adrenal Glands / Q000601:surgery; D018246:Adrenocortical Adenoma / Q000378:metabolism; D003937:Diagnosis, Differential; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000188:drug therapy; D006973:Hypertension / Q000175:diagnosis; D007008:Hypokalemia / Q000175:diagnosis; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use
D000451:Mineralocorticoid Receptor Antagonists