Primary aldosteronism

Clinical Manifestations

• Usually asymptomatic except for hypertension and hypokalemia
• Can have muscle cramps
• Family history
• Resistant hypertension
• Adrenal incidentaloma
• Early onset hypertension
• High normal sodium
• Metabolic alkalosis

Differential Diagnosis

• Bilateral adrenal hyperplasia (60%)
• Adrenal adenoma, which causes Conn syndrome
• Adrenal carcinoma (rare)
• Familial hyperaldosteronism

Diagnosis

• Screening with plasma aldosterone/plasma renin ratio
  • Done preferably in morning sample
  • Taken in a sitting position after at least 15 minutes of rest
  • Avoid aldosterone antagonists, ARBs, β-blockers
• Diagnosed with:
  • Oral salt load
  • Saline suppression
  • Captopril

Management

• Surgery if unilateral
• Spironolactone if bilateral