Primary aldosteronism — recent progress and current concepts

Abstract

Primary aldosteronism is the commonest form of hormone-related hypertension, with an estimated prevalence of 6–13% in the generalpopulation of hypertensive patients. Among patients with resistant hypertension, the proportion of PA is even higher. Through intensiveresearch in the field of basic science and the creation of large registries of patients with PA, it is possible to understand the effect ofexcess aldosterone not only on the cardiovascular system but also on the morphology and function of the other organs. Recent researchhas highlighted the differences in the regulation of calcium metabolism in patients with adrenal adenomas and PA. A lot of attention hasbeen paid to the improvement of diagnostic methods, with particular emphasis on adrenal vein sampling, which is becoming increasinglyimportant. In recent years there have been many publications on the prevalence of mutations in the potassium channel in patients withadrenal tumours and PA. A new form of familial hyperaldosteronism - FIII, has also been distinguished. Treatment of patients with PAstill relies on the use of mineralocorticoid receptor antagonists or adrenalectomy, preferably preceded by a confirmation of aldosteronesecretion lateralisation by adrenal vein sampling.