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Primary Hyperaldosteronism Screening Algorithm

Plasma aldosterone-to-renin ratio (ARR) is the cornerstone screening test for autonomous aldosterone excess in hypertensive patients with hypokalemia, treatment-resistance, or adrenal mass.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Primary Hyperaldosteronism Screening Algorithm?

Primary aldosteronism (PA) is autonomous aldosterone hypersecretion independent of the renin-angiotensin system. Causes include unilateral aldosterone-producing adenoma (Conn syndrome, 30-40%), bilateral idiopathic adrenal hyperplasia (60%), familial hyperaldosteronism types 1-4, and rarely aldosterone-producing carcinoma. Aldosterone causes sodium retention, potassium loss, and volume expansion.

Screening indications (Endocrine Society 2016): hypertension with spontaneous/diuretic-induced hypokalemia, resistant hypertension (>3 drugs), hypertension + adrenal incidentaloma, hypertension + family history of early-onset stroke (<40 years), hypertensive first-degree relatives of PA patients, and any hypertensive with stage 2 disease (BP >160/100).

Screening protocol: morning sample (after at least 2 hours upright), normal sodium intake, potassium replenishment (>4.0 mEq/L), interfering drug withdrawal (spironolactone/eplerenone 4-6 weeks; ACE/ARB and beta-blockers if possible 2 weeks). ARR >20-30 ng/dL per ng/mL/h with absolute aldosterone >10 ng/dL is suggestive. Confirmation: saline infusion (2L/4 hours, post-aldosterone >10 = positive) or fludrocortisone suppression test.

Symptoms

Resistant hypertension (>3 drugs)
Hypokalemia (spontaneous or diuretic-induced)
Muscle weakness and cramps
Polyuria and polydipsia
Headache and palpitations
Often asymptomatic (incidental)

Risk Factors

Treatment-resistant hypertension
Family history of early-onset hypertension
Adrenal incidentaloma
Spontaneous hypokalemia
Stroke at <40 years (family)
Diuretic-induced severe hypokalemia

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Hypertension uncontrolled with ≥3 drugs
  • Hypokalemia + hypertension
  • Adrenal mass detected on CT
  • Family history of PA
  • Severe hypertension at young age
  • Pre-surgery evaluation (Conn adenoma)

Treatment Methods

01
Confirm with saline infusion or sodium loading
02
Adrenal CT (4mm thin sections)
03
Adrenal venous sampling (AVS) for subtyping
04
Unilateral PA: laparoscopic adrenalectomy
05
Bilateral hyperplasia: spironolactone/eplerenone
06
Genetic testing (familial subtypes)

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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