How is the subtype of primary aldosteronism determined once a diagnosis has been confirmed?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Once the diagnosis of primary aldosteronism has been confirmed by a first- or second-tier test, the next step is to determine the subtype of primary aldosteronism and to identify surgically curable disease. For practical purposes, this means distinguishing between an adrenal adenoma and idiopathic adrenal hyperplasia (IAH). (See the chart below.) [22, 28]

Algorithm for distinguishing subtypes of primary a Algorithm for distinguishing subtypes of primary aldosteronism.

In general, patients with adenomas are younger than patients with hyperplasia and have more severe hypertension (HTN) and hypokalemia, as well as higher urinary aldosterone (U-Aldo) levels, than do patients with IAH. However, these clinical parameters are not reliable enough to accurately distinguish adenoma from IAH.


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