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Routine Screening for Primary Hyperaldosteronism in Hypertensive Patients: Yes or No?

  • Konstantinos P. Economopoulos
  • Carrie C. Lubitz
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Primary hyperaldosteronism is the most common cause of secondary hypertension and endocrine-related hypertension and is characterized by autonomous, inappropriately elevated serum aldosterone, arising from either an aldosterone producing adenoma or bilateral adrenal hyperplasia. In comparison to matched patients with primary (essential) hypertension, patients with both subtypes of primary hyperaldosteronism have increased odds of stroke, non-fatal heart attack and atrial fibrillation. Moreover, patients with primary hyperaldosteronism have worse psychosocial and quality of life scores when compared to patients with primary hypertension. Although treatment guidelines for primary hyperaldosteronism vary, diagnosis is usually focused on identifying serum hyperaldosteronism and subsequently by differentiating between unilateral and bilateral disease with imaging (CT or MRI) and/or adrenal-venous sampling. Most patients with aldosterone producing adenoma can be managed successfully with laparoscopic adrenalectomy, not only by curing their hypertension, but also by reversing cardiovascular and renal complications. Moreover, primary hyperaldosteronism patients diagnosed with bilateral-adrenal hyperplasia can likewise have improvement in hypertension and downstream cardiovascular outcomes with appropriate mineralocorticoid-receptor antagonist treatment.

Keywords

Primary hyperaldosteronism Secondary hypertension Screening Adrenal venous sampling Adrenalectomy Mineralocorticoid receptor antagonists 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Konstantinos P. Economopoulos
    • 1
  • Carrie C. Lubitz
    • 2
    • 3
  1. 1.Department of SurgeryDuke UniversityDurhamUSA
  2. 2.Department of SurgeryMassachusetts General HospitalBostonUSA
  3. 3.Institute for Technology AssessmentBostonUSA

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