Diagnosis of primary hyperaldosteronism

Abstract

Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. Moreover, it is associated with a higher cardio-metabolic risk than the observed in patients with essential arterial hypertension (EHT). Therefore, a high index of clinical suspicion for PA is mandatory. If an elevated aldosterone/renin ratio is confirmed, confirmatory tests should be performed, with the exception in those patients with florid PA, with, with spontaneous hypokalaemia, plasma aldosterone > 20 ng/dL and suppressed renin, in whom this step would not be strictly necessary. Intravenous saline infusion test or captopril test are the commonly used confirmatory tests. The last step in the diagnosis of PA is the localization study, being the computerized axial tomography (CT) of the adrenal glands the initial test of choice, and adrenal venous sampling (AVS), the definitive localization test in most cases. This review summarizes the available data about the diagnosis of PA, from screening to confirmatory study and localization.

Keywords: Adrenal venous sampling; Aldosterona plasmática; Aldosterone/renin ratio; Antagonistas del receptor de mineralocorticoides; Cateterismo de venas adrenales; Cociente aldosterona/renina; Hiperaldosteronismo primario; Mineralocorticoid receptor antagonists; Plasma aldosterone; Primary hyperaldosteronism.