Approach to the patient with hypertension and hypokalemia
- William F Young, Jr, MD, MSc
William F Young, Jr, MD, MSc
- Professor of Medicine
- Mayo Clinic College of Medicine
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Section Editors
- André Lacroix, MD
André Lacroix, MD
- Section Editor — Adrenal Disease
- Professor of Medicine
- University of Montreal, Quebec, Canada
- George L Bakris, MD
George L Bakris, MD
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
Nonsuppressible (primary) hypersecretion of aldosterone is an underdiagnosed cause of hypertension. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia. The most common subtypes of primary aldosteronism are:
●Aldosterone-producing adenomas (APAs)
●Bilateral idiopathic hyperaldosteronism (IHA; bilateral adrenal hyperplasia)
Less common forms include:
●Familial hyperaldosteronism type I (glucocorticoid-remediable aldosteronism [GRA]), type II (the familial occurrence of APA or bilateral idiopathic hyperplasia or both), and type III (associated with the germline mutation in the KCNJ5 potassium channel) (see "Familial hyperaldosteronism" and 'Genetic testing' below)
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- VARIABLE PRESENTATION OF PRIMARY ALDOSTERONISM
- OTHER CAUSES OF HYPERTENSION AND HYPOKALEMIA
- IS THERE A ROLE FOR ROUTINE SCREENING?
- Endocrine Society guidelines
- INITIAL APPROACH
- Plasma renin activity
- Plasma aldosterone to renin ratio
- - Protocol
- - Test performance
- - Nonaldosterone mineralocorticoid excess
- 24-hour urine collection
- CONFIRMATION OF THE DIAGNOSIS
- Primary aldosteronism
- - Oral sodium loading
- - Saline infusion test
- SUBTYPE CLASSIFICATION
- Adrenal CT
- - Limitations
- Adrenal vein sampling
- - Indications
- - Procedure
- - Confirming successful catheterization
- - Cortisol-corrected ratios
- Other tests
- Genetic testing
- SUMMARY AND RECOMMENDATIONS