Primary aldosteronism: The Mayo Clinic approach

Primary aldosteronism (PA) is the most common reason of secondary hypertension, that can be cured surgically or treated with targeting medical treatment. In many cases PA is not diagnosed on time, leading to aldosterone-specific cardiovascular and nephritic lesions. Effective methods of treatment make it reasonable to perform case detection testing for PA at least once in all patients with hypertension. Mayo Clinic approach is aimed to simplify primary case detection testing. There is no need to use plasma aldosterone concentration/plasma renin activity ratio, all tests can be completed, whilst the patient is taking antihypertensive and other medications. The next step is confirmatory testing. The choice of pharmacological or surgical therapy depends on the results of computed tomography scans of the adrenal glands and adrenal venous sampling. The last one is performed only after discussing with patient the advantages and disadvantages of all therapy methods and positive intention to surgery. Laparoscopic unilateral adrenalectomy is the procedure of choice in patients with unilateral adrenal disease. In patients with bilateral aldosterone hypersecretion, the optimal is a low-sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to reach a high-normal serum potassium concentration.