14 - Primary Aldosteronism: Next steps in care (18 min)

Understanding the diagnosis and treatment in primary aldosteronism (PA) often feels elusive to most providers. PA is marked by the elevation of aldosterone and the suppression of renin leading to a disproportionately higher risk of cardiovascular, kidney, and metabolic disease compared to those patients with essential hypertension, yet this condition is often undiagnosed. This episode will discuss the use of the Plasma Renin Activity lab to screen for primary aldosteronism and guideline-directed care of PA.  In today’s episode, Maeson Latsko, PhD and Millicent Kee, MSN, FNP-BC, Clinical and Education Specialists at Quest Diagnostics Center of Excellence at Cleveland Heartlab, will discuss the next steps in care once primary aldosteronism has been identified. This episode will Discuss the prevalence of PA and its impact on health (1:30) Discuss use of the PRA lab to screen for PA (4:15) Review current diagnosis and treatment guidelines for PA (mineralocorticoid receptor antagonist (MRA) treatment: 6:50, MRA considerations: 13:00) Discuss how providers can utilize current treatment guidelines (referral: 9:45, imaging: 11:00, surgical evaluation: 11:45) The content was current as of the time of recording. To learn more, please review the additional resources below for information on our cardiovascular, metabolic, endocrine, and wellness offerings as well as educational resources and insights from our team of experts. At Quest Diagnostics, we are committed to providing you with results and insights to support your clinical decisions. Date: 5/2025 Speaker(s):  Millicent Kee, MSN, FNP-BC; Maeson Latsko, PhD Contributor(s):  Maeson Latsko, PhD; Millicent Kee; MSN, FNP-BC; Trisha Winchester, PhD; Sanjay Dixit, MD; Akhil Singh   Additional Resources Ordering information: Quest Diagnostics Clinical Education Center [Link]   Plasma Renin Activity with Reflex to Aldosterone | Test Detail | Quest Diagnostics   https://www.questdiagnostics.com/healthcare-professionals/about-our-tests/endocrine-disorders/primary-aldosteronism   References:  Auchus RJ. Approaching Primary Aldosteronism as a Common Disease. Endocr Pract. 2023;29(12):994-998. doi:10.1016/j.eprac. 2023.08.014   Brown JM, Tsai LC, Abel EE, et al. Nationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program. Hypertension. 2025 Feb 21. doi: 10.1161/HYPERTENSIONAHA.125.24648.   Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi:10.1210/jc.2015-4061   Marcelli M, Bi C, Funder JW, McPhaul MJ. Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism. Hypertension. 2024;81(10):2072-2081. doi:10.1161/HYPERTENSIONAHA.124.22884