Primary aldosteronism: Are we diagnosing and operating on too few patients?

Many cases of potentially curable primary aldosteronism are currently likel y to be diagnosed as essential hypertension unless screening tests based on suppression of renin are tarried out in all hypertensive patients. More th an half of the patients with primary aldosteronism detected in this way hav e normal circulating potassium levels, so measurement of potassium is not e nough to exclude primary aldosteronism. When primary aldosteronism is diagn osed, fewer than one-third of patients are suitable for surgery as initial treatment, but this still represents a significant percentage of hypertensi ve patients. After excluding glucocorticoid-suppressible primary aldosteron ism, adrenal venous sampling is essential to detect unilateral production o f aldosterone and diagnose angiotensin-responsive aldosterone-producing ade noma. One cannot rely on the computed tomography scan. If all hypertensive patients are screened for primary aldosteronism and the workup is continued methodically in those with a positive screening test, patients with unilat eral overproduction of aldosterone who potentially can be cured surgically are not denied the possibility of cure.