Primary aldosteronism and a Texas two-step

Primary aldosteronism is unquestionably the most common secondary cause of hypertension, and effective approaches to diagnosis and targeted treatments exist. Even the most conservative estimates of the prevalence of primary aldosteronism, however, indicate that the condition is grossly underdiagnosed. Part of the reason why diagnosis and treatment lag far behind is the lack of expertise, even among endocrinologists and hypertension specialists, in the approach to the patient with possible primary aldosteronism. We will never make an impression on this important problem unless general internists and primary care physicians actively participate in the screening and referral process. A healthcare delivery team need not fear an overwhelming and fruitless battle with an intractable conundrum if a practical and staged approach to workup and treatment is taken. This review discusses the approach we have taken in Dallas, a strategy of targeted screening, referral for positive screens, and individualized management.