Primary Aldosteronism: State-of-the-Art Review

We are witnessing a revolution in our understanding of primary aldosteronism. In the past two decades, we have learned that primary aldosteronism is a highly prevalent syndrome that is largely attributable to pathogenic somatic mutations, that contributes to cardiovascular, metabolic, and kidney disease, and that when recognized, can be adequately treated with widely available mineralocorticoid receptor antagonists and/or surgical adrenalectomy. Unfortunately, primary aldosteronism is rarely diagnosed, or adequately treated, mainly because of a lack of awareness and education. Most clinicians still possess an outdated understanding of primary aldosteronism; from primary care physicians to hypertension specialists, there is an urgent need to re-define and re-introduce primary aldosteronism to clinicians with a modern and practical approach. In this state-of-the-art review, we provide readers with the most updated knowledge on the pathogenesis, prevalence, diagnosis, and treatment of primary aldosteronism. In particular, we underscore the public health importance of promptly recognizing and treating primary aldosteronism and provide pragmatic solutions to modify clinical practices to achieve this.