[Primary hyperaldosteronisms: from diagnosis to treatment].

Primary hyperaldosteronism is a growing cause of apparently essential hypertension (until 15 % of patients with hypertension). Primary hyperaldosteronism can now be recognized even for patients without hypertension or hypokaliemia. Paradoxically normal levels of aldosterone when serum renin levels and/or plasmatic renin activity and/or kaliemia are low, lead to suggest primary hyperaldostéronism. High values of aldosterone/renin or aldosterone/PRA favour the diagnosis. Adrenal scanography (fine slices) has to be performed, and confronted with one functional procedure (adrenal iodocholestérol uptake after dexamethasone, or sampling of adrenal venous blood for aldosterone measurement) only if surgery is suggested. When hypersecretion is unilateral or largely predominant in one size, surgery is very useful, when hypertension or hypokaliemia are poorly controlled, when medications are unwell tolerated, especially in men.