Response to About an Epidemic of Primary Aldosteronism
I appreciate Plouin’s1 thoughtful comments. In discussing idiopathic hyperaldosteronism, I was referring back to Padfield’s work2 indicating that the underlying pathophysiologies of idiopathic versus primary aldosteronism secondary to an aldosterone-producing adenoma are different, with the former seeming to manifest a heightened response to angiotensin II and the latter a blunted response. This is not to suggest that idiopathic hyperaldosteronism is distinct from primary aldosteronism, as I agree that it is a subtype of the disorder.
I further agree with Plouin1 that suppression testing cannot distinguish between the 2 subtypes of primary aldosteronism. As discussed in my review, lateralization of aldosterone secretion by adrenal vein sampling is required to confirm a probable aldosterone-producing adenoma and a likely favorable response to surgery.