Who Should Be Tested for PA?

It is important that you ask your primary care physician about getting tested for primary aldosteronism if you fall under one or more of the following categories:

You have resistant hypertension:

Your blood pressure is above 150/100 mm Hg on three different measurements obtained on different days, or
Your blood pressure is above 140/90 mm Hg, and does not improve despite combining three conventional antihypertensive drugs (including a diuretic), or
Your hypertension is below 140/90 mm Hg, but you are taking four or more blood pressure medications.

You have hypertension and low potassium:

A test measuring potassium in your blood indicates that your level is lower than normal.
Some diuretics (e.g., hydrochlorothiazide) usually cause hypokalemia in patients with PA, but even if you are taking a diuretic, you should be tested for primary aldosteronism if your potassium level is low and you have hypertension. The diuretic may be unmasking the underlying primary aldosteronism.

You have hypertension and an adrenal “incidentaloma:”

You have high blood pressure, and when you had a CT scan done for some other reason, you were told that you have a nodule or “bump” on one of your adrenal glands.

You have hypertension and sleep apnea:

You have high blood pressure and sleep apnea, or your primary care physician suspects you may have sleep apnea.

You have hypertension and a family history of early onset hypertension or stroke:

You are under 40, have been diagnosed with high blood pressure, and some of your relatives developed hypertension and/or had a stroke when they were under 40 years of age.

You have hypertension and a first degree relative with PA:

You have high blood pressure, and someone in your immediate family has primary aldosteronism.

Other Reasons to Be Tested

Many patients report that they developed symptoms over a decade or more, and it is now confirmed that aldosterone progressively increases over long periods of time. If you have long-standing high blood pressure, whether it is well-controlled or not, along with many of the symptoms of primary aldosteronism, it is entirely reasonable for you to request a test. Excess aldosterone leads to irreversible damage. The only way to minimize this damage is by identifying its cause.

Finding the Right Physician

Since the diagnosis of primary aldosteronism can be a complex process, it is important to request a referral to a specialist with experience in treating hyperaldosteronism (e.g., an endocrinologist, nephrologist, or cardiologist). Many patients report that finding experienced physicians can be quite challenging. To help you locate adequate care near you, the Foundation maintains a database of Centers of Excellence and PA specialists worldwide.

Other Endocrine Causes of Hypertension

Blood pressure can become difficult to control for various reasons. Although frequent, hyperaldosteronism is only one of them. Other endocrine diseases can also cause hypertension. Since they share symptoms with primary aldosteronism, the Foundation has developed a Differential Diagnosis to summarize information on these conditions.

New Diagnostic Technique

Single Blood Test Can Change Lives

The first step in diagnosis is a blood test called “Aldosterone Renin Ratio” (ARR).

References

Funder, J. W, Carey, R. M., Mantero, F., Murad, M. H., Reincke, M., Shibata, H., Stowasser, M., & Young Jr, W. F. (2016). The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 101(5), 1889–1916.
Young Jr., W. F. (2019). Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. The Journal of Internal Medicine, 285(2), 126-148.