Primary aldosteronism (Conn's syndrome)

Idiopathic (essential) hypertension is the most common cause of elevated blood pressure (BP) levels in a patient. However, up to 5%–10% of patients with elevated BP are affected by a specific and potentially reversible cause that is known as secondary hypertension. Primary aldosteronism (PA) is the most common form of endocrine hypertension. The diagnostic and therapeutic pathways for PA consist of few important steps: screening tests in high-risk population, identification of PA subtype, and treatment (surgery in case of unilateral adenoma, and if not for surgery, treatment with a mineralcorticoid receptor antagonist). Aldosterone-to-renin ratio is recommended as the initial test to screen for PA; it should be performed after giving adequate wash-out time for several interfering drugs. Confirmatory tests including captopril challenge test and saline infusion test are used if clinical conditions such as spontaneous hypokalemia and increased aldosterone levels are not sufficient to confirm PA. Before surgery, adrenal venous sampling is suggested to ensure accurate lateralization of aldosterone production.