Abstract
Although it was once thought to be relatively rare, primary aldosteronism (PA) may account for up to 5% to 10% of hypertensive patients, of which only a minority will present with hypokalemia. PA is caused by bilateral idiopathic adrenal hyperplasia (BIH) or a unilateral aldosterone-producing adenoma (APA).
Computed tomography (CT) with adrenal protocol or magnetic resonance imaging (MRI) should be performed in all patients with PA to evaluate for adrenal nodules or adrenal hyperplasia. Imaging may also help provide anatomic guidance for the interventional radiologist and surgeon. Adrenal venous sampling (AVS) should be performed in most patients with PA, to distinguish between bilateral and unilateral disease, because this would affect the recommendations for management.
Medical management of BIH consists of mineralocorticoid receptor antagonists, such as spironolactone or eplerenone, in combination with other antihypertensive agents. For patients with APA, adrenalectomy is recommended, and minimally invasive approaches (transabdominal or posterior retroperitoneal) are appropriate.