Which patients should be screened for primary hyperaldosteronism?

Updated: Sep 08, 2020
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Evaluation of a patient in whom hyperaldosteronism is suggested has several distinct stages. The finding of hypertension, hypokalemia, or both most commonly precipitates the decision to screen. The presence of these 2 features together has a 50% predictive value.

Screening for PA is recommended for patients with Joint National Commission (JNC) stage 2 (>160–179/100–109 mm Hg), stage 3 (>180/110 mm Hg), or drug-resistant hypertension (defined as systolic BP >140 and diastolic BP >90 despite treatment with 3 hypertensive medications); hypertension and spontaneous or diuretic-induced hypokalemia; hypertension with adrenal incidentaloma; or hypertension and a family history of early onset hypertension or cerebrovascular accident at a young age (< 40 y); and all hypertensive first-degree relatives of patients with PA. Additionally, in patients younger than 20 years or those with a family history of PA or stroke at a young age (< 40 y), or with an onset at a young age (eg, < 20 y), genetic testing for glucocorticoid-remediable aldosteronism is suggested. [24, 27]

The first step in the workup entails confirming that hyperaldosteronism is present and, if it is not present, excluding other conditions that produce a similar picture. The next step involves differentiating primary causes of hyperaldosteronism from secondary causes.

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