AACE MENA 2025-Primary Aldosteronism

Video Transcription

Video Summary

The presentation focused on primary aldosteronism (PA), a common but underdiagnosed cause of hypertension with significant cardiovascular risks independent of blood pressure control. Key objectives included recognizing PA’s spectrum, applying updated diagnostic strategies—especially aldosterone-renin ratio screening and adrenal vein sampling (AVS)—and understanding current and emerging treatments.<br /><br />Screening is now recommended for all hypertensive patients, shifting from prior restrictive criteria, due to PA’s prevalence (up to 15% in hypertension and 25% in resistant hypertension). Diagnosis involves careful interpretation of aldosterone, renin, and potassium levels, accounting for medications that can cause false positives or negatives. Confirmatory suppression testing and imaging (CT) guide further evaluation, though AVS remains the gold standard for distinguishing unilateral from bilateral disease.<br /><br />Treatment aims beyond blood pressure control. Mineralocorticoid receptor antagonists (MRAs) like spironolactone or plurinone are essential, with titration guided by achieving renin levels above one to reduce cardiovascular risk. Surgery (adrenalectomy) is favored for unilateral disease but requires precise lateralization with AVS due to poor CT correlation.<br /><br />Emerging therapies include selective MRAs (esaxerenone) and aldosterone synthase inhibitors (dextrostat), which may improve outcomes. Future directions involve advanced imaging and novel ablative procedures. Ultimately, broad screening, individualized diagnosis, and targeted treatment are crucial to preventing PA-related organ damage.

Keywords

primary aldosteronism

hypertension screening

aldosterone-renin ratio

adrenal vein sampling

mineralocorticoid receptor antagonists

adrenalectomy

emerging therapies