Figure 4. Serial ARR measurements: examples of documentation of progression of primary aldosteronism (renin-independent aldosterone production).

Mr KS: A 84-year-old male patient with resistant hypertension. (Adrenal imaging: Adrenal glands are normal in size, shape and attenuation values.)

Ms PR: A 71-year-old female patient with resistant hypertension. (Adrenal imaging: Small hypodense lesion 5.6 x 6.2 mm, within the medial limb of the left adrenal gland.)

Ms SK: A 64-year-old female patient with resistant hypertension (Adrenal imaging: CT adrenals ordered; Ultrasound adrenal areas normal).

Mr SS: A 68-year-old male patient, with no history of hypertension (Adrenal imaging: 20 x 19 mm incidentaloma; HU -12).

Recognizing the continuum nature of PA and marking the newly proposed stage of “Pre-Primary Aldosteronism” (ARR 11-20) can enhance early disease detection (renin-independent aldosterone production), monitor progression (periodic rescreening), optimize treatment, and mitigate end-organ damage in RH.

ARR: aldosterone renin ratio; RH: resistant hypertension; PA: primary aldosteronism