At what age is primary hyperaldosteronism (Hyperaldosteronism) typically diagnosed?

From the Guidelines

Primary hyperaldosteronism typically presents in adults between the ages of 30 and 60, with the average age of diagnosis being around 40-50 years, as reported in the most recent guidelines 1. People usually present with resistant hypertension (high blood pressure that requires multiple medications to control), unexplained hypokalemia (low potassium levels), or both. Some patients may be asymptomatic and discovered incidentally during evaluation for hypertension. The condition can also manifest with symptoms related to hypokalemia such as muscle weakness, cramping, headaches, or fatigue.

Key Considerations

• Diagnosis involves screening tests including plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio, followed by confirmatory tests such as salt loading tests or captopril challenge, as outlined in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
• Imaging studies like CT scans or MRI are then used to determine if the cause is an adrenal adenoma (Conn's syndrome) or bilateral adrenal hyperplasia.
• While primary hyperaldosteronism can occur at any age, it is uncommon in children and adolescents, and secondary hyperaldosteronism, which results from activation of the renin-angiotensin system, can occur at any age depending on the underlying cause, such as renal artery stenosis, heart failure, or cirrhosis.

Management

• The management of primary aldosteronism depends on its subtype, particularly on adrenal lesions being unilateral or bilateral, because the unilateral forms are amenable to surgical treatment while the latter require lifelong medical treatment, as stated in the 2024 ESC guidelines 1.
• For unilateral primary aldosteronism, surgical removal of the offending adrenal gland is typically considered, unless the patient is older or has co-morbidities of concern.
• Medical treatment is currently based on MRAs, such as spironolactone or eplerenone, with the effective dose usually 50–100 mg once daily, and can be titrated up to 300–400 mg once daily, if necessary, as recommended in the guidelines 1.

From the Research

Presentation and Diagnosis of Hyperaldosteronism

• The age at which people present with hyperaldosteronism is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, it is mentioned that primary aldosteronism is a common cause of secondary hypertension, which can occur at any age 3, 4.
• The diagnosis of hyperaldosteronism is a multistep process that involves screening, confirmatory testing, and subtype differentiation 4.
• The aldosterone-to-renin ratio (ARR) is the primary test for screening primary aldosteronism, and confirmatory tests such as oral sodium loading or saline infusion test are necessary to confirm the diagnosis 3.

Age-Related Diagnosis

• There is no specific information provided on the exact age at which hyperaldosteronism is typically diagnosed 2, 3, 4, 5, 6.
• However, it is suggested that approximately 30% of all hypertensive patients may be affected by primary aldosteronism, which can occur at any age 5.
• The importance of recognizing primary aldosteronism lies in its potential to cause significant cardiovascular and renal damage, which can be mitigated with proper diagnosis and treatment 3, 4.