Difficulties in diagnosing primary hyperaldosteronism

Primary hyperaldosteronism (PA) is a disorder with excessive secretion of aldosterone, uncontrolled of regulation of the renin-angiotensin system. Excess secretion of aldosterone leads to the development of hypertension, hypokalemia and specific damage to the cardiovascular system and kidneys. The prevalence of PA was previously underestimated, but at the moment, according to studies, it is the most common cause of secondary arterial hypertension. The most common causes of PA are adrenal adenoma and adrenal hyperplasia. The importance of timely diagnosis of PA lies not only in solving the problem of high blood pressure, but because of the extremely adverse effect of excess aldosterone on the cardiovascular system and kidneys, which can even lead to death. The aldosterone-to-renin ratio (ARR) has long been a selective test for PA screening, but the complexity of its interpretation, the lack of clear cut-off level, and the confusion of measurement units make it difficult to evaluate, which has led some researchers to look for new ways for PA screening. The distinction between idiopathic adrenal hyperplasia (IAH) and aldosterone-producing adenoma (APA) is important for choosing the appropriate treatment. Therefore, imaging exams such as computed tomography and invasive studies such as adrenal catheterization are required to identify the PA subtype. Depending on the subtype of PA, it is necessary to use the optimal treatment — surgical for APA or pharmacological for hypertension, using drugs such as mineralocorticoid receptor antagonists.