[Fifty years of subclinical primary aldosteronism: importance of early diagnosis].

[adrenal incidentaloma]

Clinical presentation of excessive aldosterone secretion is often not specific . The presence of resistant severe hypertension (HT ) and signs of hypokalemia is useful but inconsistent characteristic . Plasma aldosterone level in primary aldosteronism (PA ) could be normal , although inappropriately high for a low plasma renin activity and not suppressed by sodium . Screening of hypertensive population with no obvious signs of PA has revealed an increased prevalence of idiopathic adrenal hyperplasia as a cause of aldosterone excess . Nowadays , PA is the most common endocrine form of secondary HT , with an estimated prevalence 5 -10 % of hypertensive population . The diagnosis of PA can lead to surgical cure in the case of aldosterone producing adenoma and unilateral adrenal hyperplasia . The aldosterone excess is responsible for vascular inflammation and end-organ damage . Left ventricular hypertrophy , cardiac arrhythmia and cerebral insult are frequently seen in PA and preventable by mineralocorticoid receptor blockers . For this reason , screening for PA in patients with HT and hypokalemia and /or adrenal incidentaloma , resistant and severe HT , and in patients with the onset of HT at young age is advisable .The most widely accepted screening for PA is serum aldosterone to plasma rennin activity (aldosterone : PRA ) ratio , with the cut-off of 30 ng /dl :ng /ml /h . Serum aldosterone level could be included as an additional screening parameter . Confirmatory tests are crucial for the diagnosis of PA in patients with an increased aldosterone : PRA ratio and subtype differentiation for the choice of treatment .

Diseases
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Diseases presenting "severe hypertension" symptom

adrenal incidentaloma

cadasil

cushing syndrome

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