Primary aldosteronism and its variants.

Primary aldosteronism is an adrenal abnormality in which there is an excessive production of aldosterone above that required for electrolyte homeostasis which is not driven by known stimulators of aldosterone secretion, although these may retain some degree of modulatory activity on aldosterone secretion. In the early years following the description of primary aldosteronism, the etiology was ascribed to the autonomous production of aldosterone by an adrenal adenoma for which surgical treatment resulted in the resolution of the hypokalemia and cure or w x improvement of the hypertension in many cases 1 . At this time the possibility of aldosteronism due to adrenal hyperplasia was not recognized. The traditional clinical picture was characterized by salt-sensitive hypertension associated w x with hypokalemia and suppression of renin secretion 1 . A major emphasis in the selection of patients for consideration for diagnostic procedures for primary aldosteronism was the presence of spontaneous or easily-induced hypokalemia, resulting in an underestimation of the incidence w x of primary aldosteronism 2,3 . Once identified, normokalemic primary aldosteronism was found to be common; many patients with primary aldosteronism are w x normokalemic most of the time 2,4,5 . The widespread commercial availability of methods to easily measure alŽ . dosterone and plasma renin activity PRA allowed the screening of patients with essential hypertension, irrespective of the serum potassium, and has led to the recognition that primary aldosteronism has higher prevalence than w x previously recognized 2,6,7 . Various stimulatory and localization maneuvers have led to the recognition that there are several types of primary aldosteronism with variable w x response to surgery 8–10 . The purpose of this mini review is to succinctly address the issues of prevalence, sub types and pathogenesis of primary aldosteronism so that appropriate therapy may be chosen.