Therapeutic Outcomes with Surgical and Medical Management of Primary Aldosteronism

Purpose of Review Primary aldosteronism (PA) is the most common cause of secondary hypertension and is significantly under-diagnosed. Delays in diagnosis and treatment can lead to cardiovascular morbidity and mortality. The goal of this study is to review the management of PA, with a focus on medical and surgical treatment outcomes. Recent Findings PA causes cardiovascular dysfunction in excess of degree of hypertension. Adrenalectomy demonstrates a therapeutic advantage over mineralocorticoid antagonist (MRA) therapy, after controlling for degree of hypertension and subtype of PA. Higher rates of atrial fibrillation, heart failure, stroke, and incidence of chronic kidney disease are observed in subjects treated with MRAs than in subjects treated with adrenalectomy. The therapeutic benefit of surgery may reflect definitive resolution of excess aldosterone. Complete mineralocorticoid blockade may achieve similar benefit to adrenalectomy. Adrenalectomy is the most effective treatment for unilateral PA. Biomarkers for MRA therapy might inform optimal medical therapy of bilateral adrenal hyperplasia.

Automated summary

Primary aldosteronism (PA) is the most common cause of secondary hypertension, and delays in diagnosis and treatment can lead to cardiovascular morbidity and mortality. Surgical treatment (such as adrenalectomy) may be more effective than medical treatment (such as MRA) and can reduce the occurrence of atrial fibrillation, heart failure, stroke, and chronic kidney disease.