Primary aldosteronism: part II: subtype differentiation and treatment.

After discussing in Part I (Rossi et al, J Nephrol. 2008;21:447-454) the screening strategy to identify the hypertensive patients with primary aldosteronism (PA), we report here an update on the methodology for the further diagnostic work-up and treatment of PA patients. The most common forms of PA are aldosterone-producing adenoma (APA) and adrenocortical hyperplasia (BAH), which are unilateral or bilateral sources of aldosterone excess secretion, respectively. Since APA needs a surgical approach, in contrast to BAH which requires medical treatment, it is crucial to clearly delineate a diagnostic work-up aimed at discriminating the 2 forms. Clinical usefulness and accuracy of adrenal vein sampling, imaging tests (e.g., computed tomography and magnetic resonance) and mineralocorticoid adrenocortical scintigraphy are discussed in detail.