Key result
A multistep diagnostic protocol including screening, confirmatory testing, and selective adrenal venous sampling is crucial for the management of primary aldosteronism.
Primary aldosteronism requires a multistep diagnostic evaluation including screening, confirmatory testing, and selective adrenal venous sampling to guide appropriate surgical or medical management.
May aid surgical candidate selection; leaves open prospective validation of protocol variations.
PURPOSE OF REVIEW: To illustrate the steps for clinical management of primary aldosteronism from screening evaluation to surgical and/or medical treatment. RECENT FINDINGS: 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. SUMMARY: 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.
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Boscaro et al. (2008) conducted a review in Primary aldosteronism. Diagnostic protocol and management was evaluated. A multistep diagnostic protocol including screening, confirmatory testing, and selective adrenal venous sampling is crucial for the management of primary aldosteronism.
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