Urgent need to include new tools for primary aldosteronism

People with hypertension doubled between 1990 and 2019, from 650 million to 1.3 billion and most of them remain unaware of their disease. Moreover, a large majority of treated patients do not reach the treatment goals, resulting in cardiac and neurovascular comorbidities. Among causes, primary aldosteronism (PA) is an important actor and aldosterone in excess constitute per se an organ risk factor for cardiac fibrosis. We illustrate the difficulty to evaluate patients with actual tools and the importance to get new criteria to diagnose PA. A 50-year-old woman was admitted at ICU after a routine blood test showing hypokaliemia (1.54 mmol/L). She was treated by triplixam 10/2.5/10 for 4 years. She never showed symptoms of hypokaliemia. A CT scan showed a homogenous right adrenal adenoma (density < 10UH in spontaneous contrast). After correction, screening for PA was performed (PAC: 173 ng/L-PRA: 13.92 ng/mL: h-ARR: 1.2). Adrenal venous sampling was unable to report any lateralization. The “SPACE” score [1] had a positive result of 16.5. Right adrenal surgery rapidly normalized her HTA and kaliemia. Primary aldosteronism is a frequent disease and should be screened in many hypertensive patients. Actually, there are no absolute screening criteria and interpretation includes PAC, PRA and ARR evaluation. Adrenal venous sampling is usually needed to confirm surgery indication. However, this tool is not always conclusive. New tools such as the “SPACE” score seems to be an interesting approach.