From the Guidelines
The correct answer is (c) hypertension, as primary hyperaldosteronism is characterized by autonomous overproduction of aldosterone from the adrenal glands, leading to increased sodium reabsorption and potassium excretion, resulting in hypertension 1. Primary hyperaldosteronism, also known as Conn's syndrome, is the most common form of secondary hypertension, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Characteristics of Primary Hyperaldosteronism
- Hypertension is a key characteristic, often resistant to conventional antihypertensive therapy
- Hypokalemia, not hyperkalemia, is a common feature due to increased potassium excretion
- Metabolic alkalosis and suppressed plasma renin activity, not hyper-reninism, are also typical
- The condition affects the zona glomerulosa of the adrenal cortex, where aldosterone is produced, not the zona reticularis or zona fasciculata
Treatment Options
- Surgical removal of an adenoma if present, or medical management with mineralocorticoid receptor antagonists like spironolactone or eplerenone, as recommended in the 2024 ESC guidelines 1
- Newer agents, such as finerenone and exarenone, and the aldosterone synthase inhibitor baxdrostat, are also being tested for treating primary aldosteronism 1
From the Research
Characteristics of Primary Hyperaldosteronism
- Hypertension is a common characteristic of primary hyperaldosteronism, as it is the underlying cause of hypertension in primary care settings in approximately 6% of cases 2.
- Primary hyperaldosteronism is often associated with hypokalemia, rather than hyperkalemia, as it contributes to hypertension development by inducing sodium and water retention 3.
- The condition is characterized by autonomous aldosterone secretion, which is not driven by renin, making hyper-reninism an unlikely characteristic of primary hyperaldosteronism 4, 5.
- Hyperplasia of the zona glomerulosa, rather than the zona fasciculata or zona reticularis, is often associated with primary hyperaldosteronism, as it is the site of aldosterone production in the adrenal glands 6.
Diagnosis and Management
- The diagnosis of primary hyperaldosteronism involves measuring plasma aldosterone concentration and plasma renin activity, and an elevated aldosterone-renin ratio indicates independent aldosterone secretion 2, 5.
- Confirmatory tests, such as the captopril challenge, oral or intravenous salt loading, or fludrocortisone suppression, are used to confirm the diagnosis 2, 4.
- Treatment options include adrenalectomy for patients with unilateral primary hyperaldosteronism and mineralocorticoid receptor antagonists for those with bilateral production 2, 4, 6.