Primary Hyperaldosteronism: Epidemiology, Diagnosis, and Clinical Associations - PubMed
6 hours ago
- #Primary Aldosteronism
- #Hypertension
- #Clinical Associations
- Primary aldosteronism (PA) is the leading cause of secondary hypertension, characterized by autonomous aldosterone hypersecretion, affecting 5-10% of hypertensive populations.
- Screening indications include resistant/severe hypertension, hypokalemia, adrenal incidentaloma, young-onset disease, obstructive sleep apnea, and familial history, with aldosterone-renin ratio (ARR) as the primary tool.
- PA subtypes include unilateral aldosterone-producing adenoma (APA) and bilateral idiopathic hyperaldosteronism (IHA), diagnosed via adrenal venous sampling (AVS), often complicated by technical and assay variability.
- Comorbidities encompass cardiovascular events (13.6% MACE at 5.8 years), stroke, renal impairment, metabolic disorders, and associations with vertebral fractures, renal stones, and normal-tension glaucoma.
- Psychiatric comorbidities like depression/anxiety affect 30-70% of patients, potentially due to central mineralocorticoid receptor effects, with sleep disturbances more prominent in females.
- Future improvements require enhanced screening protocols, standardized ARR cutoffs, advanced imaging, and research on cost-effective methods and psychiatric-metabolic links.