Hyperaldosteronism: Screening and Diagnosis

1. Screening for hyperaldosteronism should be considered for the following patients (Grade D):
   1. Unexplained spontaneous hypokalemia (K+ less than 3.5 mmol/L) or marked diuretic-induced hypokalemia (K+ less than 3.0 mmol/L);
   2. Resistant to treatment with three or more drugs;
   3. An incidental adrenal adenoma.
2. Screening for hyperaldosteronism should include assessment of plasma aldosterone and plasma renin activity or plasma renin (Supplemental Table S7).
3. For patients with suspected hyperaldosteronism (on the basis of the screening test, Supplemental Table S7, item ii), a diagnosis of primary aldosteronism should be established by demonstrating inappropriate autonomous hypersecretion of aldosterone using at least one of the maneuvers listed in Supplemental Table S7, item iv. When the diagnosis is established, the abnormality should be localized using any of the tests described in Supplemental Table S7, item iii. When the diagnosis is established, the abnormality should be localized using any of the tests described in Supplemental Table S7, Item iv.
4. In patients with primary hyperaldosteronism and a definite adrenal mass who are eligible for surgery, adrenal venous sampling is recommended to assess for lateralization of aldosterone hypersecretion. Adrenal vein sampling should be performed exclusively by experienced teams working in specialized centres (Grade C).