Hyperaldosteronism

Primary hyperaldosteronism (PA) is defined by dysregulated autonomous renin-independent hyperaldosteronism in the setting of intravascular volume expansion and sodium excess. In the most overt presentation, PA entails profound hypertension with chronic hypokalemia. Compared to cohort-matched patients with essential hypertension, patients with PA have worse cardiovascular disease, renal dysfunction, and mortality. Therefore, the primary aim of treatment is neutralizing the effect of pathologic aldosterone-mediated mineralocorticoid receptor (MR) activation rather than merely normalizing blood pressure. The Endocrine Society practice guidelines recommend minimally invasive adrenalectomy for patients with unilateral disease and long-term MR antagonist therapy for patients with bilateral disease or surgery contraindications.