The management of patients with primary aldosteronism.

The diagnosis of primary aldosteronism is based upon low plasma renin and elevated unsuppressible aldosterone. Computerized tomography and selective venous sampling are the most accurate methods of localization. In patients with an aldosteronoma, unilateral adrenalectomy is performed preferably via the posterior or flank approach. Patients with bilateral adrenal hyperplasia are treated with spironolactone rather than surgery, although controversy exists regarding the management of patients with macronodular hyperplasia.