Guidelines for primary aldosteronism screening
Screening for primary aldosteronism (Conn's syndrome) with plasma aldosterone, renin levels and plasma aldosterone/renin ratio (ARR) is recommended for people who meet one of these criteria:
Sustained blood pressure above 150/100 in three separate measurements taken on different days
Hypertension resistant to three conventional antihypertensive drugs
Hypertension is controlled with four or more medications
Hypertension with hypokalemia
Hypertension with adrenal incidentaloma
Hypertension and sleep apnea
Hypertension with family history of early-onset hypertension or stroke before age 40
All hypertensive first-degree relatives of patients with primary aldosteronism.
Usually, when ARR is high (high aldo low renin), the next step is CT abdomen to evaluate for adrenal adenoma or adrenocortical carcinoma. Adrenal venous sampling (VAR) by IR can differentiate unilateral from bilateral pathology in surgical candidates, unless there is an obvious unilateral mass causing the hyperaldosteronism.
If primary hyperaldosteronism (PA) is earlier than 20 years of age or there is a family history of PA or stroke at a young age (<40 years), then genetic testing for familial hyperaldosteronism type 1 (FH-I) (glucocorticoid remediable aldosteronism [GRA]) is recommended. In very young patients with PA, testing for germline mutations in KCNJ5 causing familial hyperaldosteronism type 3 (FH-III) is recommended.
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