Diagnosis and treatment of primary aldosteronism

For unilateral disease, surgery offers the possibility of cure with total laparoscopic unilateral adrenalectomy the treatment of choice. Bilateral forms are mainly treated with mineralocorticoid receptor antagonists. Prompt diagnosis of primary aldosteronism and implementation of targeted treatment strategies mitigate aldosteronespecific target organ damage, and outcomes are excellent with appropriate patient management. Advances in molecular histopathology challenge the traditional concept of primary aldosteronism as a binary disease, in which unilateral aldosterone-producing adenoma is juxtaposed with bilateral adrenal hyperplasia. Somatic mutations drive autonomous aldosterone production in most adenomas.