Vnitr Lek 2026, 72(3):176-182 | DOI: 10.36290/vnl.2026.037

Primary aldosteronism: diagnosis and treatment in clinical practice

Ondřej Petrák

3. interní klinika VFN a 1. LF UK v Praze

Primary aldosteronism is the most common cause of secondary endocrine hypertension, with a prevalence of 5-14% among hypertensive patients. It is caused by autonomous aldosterone overproduction from the adrenal cortex, leading to sodium retention and the development of hypertension, often accompanied by significant hypokalemia. Compared with essential hypertension, primary aldosteronism is associated with an increased cardiovascular and renal risk, independent of blood pressure levels. This article provides a concise overview of the pathophysiology, clinical manifestations, and complications of primary aldosteronism and focuses on a practical diagnostic approach, including indications for screening, interpretation of the aldosterone-to-renin ratio, confirmatory testing, and the role of adrenal venous sampling. Current therapeutic options are reviewed, encompassing surgical treatment of unilateral disease and pharmacological therapy with mineralocorticoid receptor antagonists. Early diagnosis and targeted treatment significantly reduce end-organ damage and improve patient prognosis.

Keywords: primary aldosteronism, renin, aldosterone, adrenal venous sampling, spirolactone, eplerenone.

Accepted: April 23, 2026; Published: May 18, 2026  Show citation