An Individualized Approach to the Evaluation and Management of Primary Aldosteronism.

OBJECTIVE With the increased emphasis on personalized and individualized medicine, the American Association of Clinical Endocrinologists Adrenal Scientific Committee has developed a series of articles to update members on personalized medicine as it applies to adrenal diseases. METHODS We synthesized literature reviews, guidelines from professional societies, and personal experience. RESULTS Since Conn described primary aldosteronism (PA) over 60 years ago, debate has raged about the prevalence of PA in the hypertensive population, the wisdom of broadly screening for PA, and prudent approaches to evaluate and manage these patients. Accumulated data from multiple centers around the globe have begun to crystallize the clinical characteristics about these patients, which allows for an individualized approach before the diagnosis of PA is even established. Evidence-based criteria for screening, improved and widely available clinical assays, and validated algorithms for evaluation empower all endocrinologists to address this complex disease in an effective manner. CONCLUSION Breakthroughs in the pathogenesis and evolution of PA illustrate why our thinking about this disease must remain flexible: PA is not a rare and uniform condition, but rather a common syndrome with protean manifestations. ABBREVIATIONS A/C = cortisol-corrected aldosterone concentration; ACE = angiotensin-converting enzyme; APA = aldosterone-producing adenoma; APCC = aldosterone-producing cell cluster; ARB = angiotensin receptor blocker; ARR = aldosterone-to-renin ratio; AVS = adrenal venous sampling; CT = computed tomography; ENaC = epithelial sodium channel; GRA = glucocorticoid remediable aldosteronism; IHA = idiopathic hyperaldosteronism; LI = lateralization ratio; MR = mineralocorticoid receptor; MRI = magnetic resonance imaging; PA = primary aldosteronism; PRA = plasma renin activity; SRA = surgical remediable aldosteronism.