Primary aldosteronism (PA), characterized by inappropriately high concentrations of the adrenal derived hormone aldosterone, is the most common endocrine cause of arterial hypertension. Compared to essential hypertension, patients with PA have a significantly increased cardiovascular risk that cannot be fully reversed by common antihypertensive treatment because of blood pressure independent deleterious effects of aldosterone. The aldosterone to renin ratio (ARR), reflecting the degree of aldosterone excess, is the classic screening test for PA, but thresholds for an elevated ARR vary substantially and are arbitrary as there exists a wide disease continuum that spans from pre-clinical stages to overt PA. Treatment approaches for PA with either mineralocorticoid receptor (MR) antagonists for bilateral disease or unilateral adrenalectomy for aldosterone producing adenomas (APA) are highly effective to mitigate the excess cardiovascular risk associated with PA. Subtype classification according to this dichotomous concept of unilateral PA, mainly due to APAs, versus bilateral PA, mainly due to bilateral adrenal hyperplasia, has been recently challenged by advances in the pathophysiologic understanding and therapeutic spectrum of PA. The implementation of current PA guidelines into clinical routine is extremely poor, reflected by the fact that most patients suffering from PA remain undiagnosed and probably untreated requiring pragmatic approaches to address this public health problem. In this review, we present an up-to-date overview on the clinical significance, diagnosis and treatment of PA with the aim to provide a guidance for clinicians regarding the management of this disease paying particular attention to a feasible implementation into daily clinical routine.

中文翻译：

---

原发性醛固酮增多症 2.0：临床医生诊断和治疗的更新。

原发性醛固酮增多症 (PA) 的特征是肾上腺衍生激素醛固酮浓度过高，是动脉高血压最常见的内分泌原因。与原发性高血压相比，PA 患者的心血管风险显着增加，由于醛固酮的与血压无关的有害作用，普通降压治疗无法完全逆转这一风险。醛固酮与肾素比率 (ARR) 反映了醛固酮过量的程度，是 PA 的经典筛查测试，但 ARR 升高的阈值差异很大并且是任意的，因为存在从临床前阶段到临床阶段的广泛疾病连续体。公开的 PA。使用盐皮质激素受体 (MR) 拮抗剂治疗双侧疾病或单侧肾上腺切除术治疗醛固酮腺瘤 (APA) 的 PA 治疗方法对于减轻与 PA 相关的过度心血管风险非常有效。根据单侧 PA（主要由于 APA）和双侧 PA（主要由于双侧肾上腺增生）二分概念进行的亚型分类，最近受到 PA 病理生理学理解和治疗范围进展的挑战。目前 PA 指南在临床常规中的实施情况极差，大多数 PA 患者仍未得到诊断，也可能未得到治疗，需要采取务实的方法来解决这一公共卫生问题。在这篇综述中，我们对 PA 的临床意义、诊断和治疗进行了最新概述，旨在为临床医生提供有关该疾病管理的指导，特别关注在日常临床常规中的可行实施。