Description
Primary aldosteronism (PA or Conn’ syndrome) is the most common secondary form of arterial
hypertension, with an estimated prevalence ranging between 6% and 20% in patients with resistant
hypertension. The use of aldosterone-renin ratio (ARR) for screening contributes to the increased
diagnostic rate of this disease. Diagnosis of primary aldosteronism consists of an initial screening test
and subsequent confirmatory tests. A prompt recognition of this disease and early institution of treatment
is vital to protecting patients from aldosterone-related blood pressure control and attenuated
cardiovascular events. Aldosterone-producing adenoma and bilateral adrenal hyperplasia (microor
macro-nodular) are the two main subtypes, constituting more than 90% of primary aldosteronism
cases.
Aldosterone-producing adenoma (APA) is typically managed with laparoscopic adrenalectomy.
Idiopathic hyperaldosteronism (IHA) is amenable to medical therapy with mineralocorticoid receptor
antagonists. Adrenal image is not accurate for distinguishing between an APA and IHA. Adrenal venous
sampling (AVS) is therefore essential for selecting the appropriate therapy for patients with a high
probability of PA who require surgical treatment. Short-term treatment outcome is determined by
factors such as pre-operative blood pressure level and hypertension duration, but evidence on long-term
outcome and survival after therapy is still lacking.
The purpose of this review is to provide up-to-date information on the etiology as well as strategies
for the subtype lateralization and the management of PA.