Screening for Surgically Correctable Hypertension Caused by Primary Aldosteronism

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Abstract
Hypertension and hypokalemia related to excessive aldosterone secretion by an adrenal adenoma was first described by Jerome Conn in 1955.1 Since that time, four subgroups of patients with primary aldosteronism have been characterized, including those with aldosteroneproducing adenoma (APA), idiopathic hyperaldosteronism (IHA), glucocorticoid remediable hyperaldosteronism, and indeterminant hyperaldosteronism.2-4 Of these causes of primary aldosteronism, APA accounts for approximately 60% and IHA for about 40%, and the other two disorders are rare. Only patients with APA predictably respond to a specific surgical approach with normalization of blood pressure,5 so that identification of primary aldosteronism and differentiation from the other forms of the disease have important clinical relevance. Nevertheless, a convenient, economical, and reliable diagnostic screening test for surgically correctable primary aldosteronism heretofore has not been available; and patients suspected as having surgically remediable hypertension caused by primary aldosteronism have had to be admitted to the hospital for a

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