Primary Hyperaldosteronism

In a nutshell

Autonomous aldosterone secretion, independent of renin, drives renal sodium retention and potassium/hydrogen loss, producing hypertension (near-universal) and hypokalaemia (present in only a minority). The aldosterone:renin ratio is the screening test; imaging and vein sampling then distinguish unilateral adenoma from bilateral hyperplasia.

Classic presentation

Resistant or difficult-to-control hypertension, sometimes with muscle weakness, cramps or polyuria from hypokalaemia, in a patient with a suppressed renin and raised aldosterone.

Key points

• 1The defining biochemical pattern is high aldosterone with suppressed renin, reflecting autonomous secretion rather than appropriate renin-driven activation.