Many cases of potentially curable primary
aldosteronism are currently likely to be diagnosed as
essential hypertension unless screening tests based on suppression of
renin are carried out in all hypertensive patients. More than half of the patients with primary
aldosteronism detected in this way have normal circulating
potassium levels, so measurement of
potassium is not enough to exclude primary
aldosteronism. When primary
aldosteronism is diagnosed, fewer than one-third of patients are suitable for surgery as initial treatment, but this still represents a significant percentage of hypertensive patients. After excluding
glucocorticoid-suppressible primary
aldosteronism, adrenal venous sampling is essential to detect unilateral production of
aldosterone and diagnose
angiotensin-responsive
aldosterone-producing
adenoma. One cannot rely on the computed tomography scan. If all hypertensive patients are screened for primary
aldosteronism and the workup is continued methodically in those with a positive screening test, patients with unilateral overproduction of
aldosterone who potentially can be cured surgically are not denied the possibility of cure.