Bilateral aldosterone production is most common in primary aldosteronism found by screening within primary care

OBJECTIVE Primary aldosteronism (PA) is the most common cause of secondary hypertension, and implies high risk of cardiovascular complications. Previously, our group had screened 1181 unselected Swedish primary care hypertensive patients, to find PA prevalence of 4,5%. The current study describes results of further diagnostics and specific treatment of these PA patients. DESIGN Prospective evaluation of lateralization and treatment of patients with PA. PATIENTS Fifty-three individuals with PA diagnosed by screening carried out in strict accordance with the current guidelines. MEASUREMENTS All patients accepting possible surgery underwent adrenal venous sampling, complemented, if unsuccessful, by adrenal cortex-specific positron emission tomography. Lateralizing cases were advised laparoscopic adrenalectomy. Bilateral ones were treated by mineralocorticoid receptor antagonists. Treatment results were assessed by at least 6 - 12 months of follow-up. RESULTS Localizing studies were accepted by 45 patients, 8 patients declined. Lateralized disease was found in 14 cases. Of 11 operated cases 3 had adenoma (prevalence 7-13%). Remaining operated cases comprised micro- and macronodular pathology. Thirty-one patients had bilateral PA. Screening and specific PA treatment led to better blood pressure and raising renin signifying risk amelioration. Both surgical and conservative treatment were tolerated well even when mainly conducted at regional healthcare level. CONCLUSIONS Bilateral production of aldosterone is common in a patient cohort derived from screening within primary care. Lateralization may be due to either adenoma, which is very rare, or due to nodular forms of PA, and both are successfully treated with adrenalectomy.