Primary aldosteronism.

Primary aldosteronism occurs much more commonly than generally appreciated. Diagnosis is facilitated by measuring urinary aldosterone excretion in conjunction with determination of the level of plasma aldosterone suppression after infusion of 2,000 mL of normal saline over 4 hours. Multiple diagnostic procedures are required to determine the specific type of primary aldosteronism. Patients with aldosterone-producing tumors, unilateral adrenal hyperplasia, and primary adrenal hyperplasia are treated surgically, whereas those with bilateral zone glomerulosa hyperplasia and glucocorticoid-remediable aldosteronism are treated medically.