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Current Screening Methods for Primary Aldosteronism: A Call for Change

A recent study published in the journal Hypertension, an outlet of the American Heart Association, highlights a pressing issue in the diagnosis of primary aldosteronism (PA). This hormonal disorder is a leading cause of high blood pressure and can significantly increase the risk of serious health issues, including heart attacks and strokes. The alarming conclusion drawn from the study indicates that existing medical guidelines may be missing nearly half of the patients affected by this condition, putting them at risk for untreated complications.

Understanding Primary Aldosteronism

Primary aldosteronism occurs when the adrenal glands produce excessive aldosterone, a hormone that plays a crucial role in regulating sodium and potassium levels in the blood. High blood pressure is a key characteristic of PA, but patients may also experience common symptoms, such as headaches or muscle cramps. Left unchecked, this disorder could lead to severe cardiovascular problems.

In 2025, new guidelines were released by the Endocrine Society, advocating for routine screening of patients with hypertension for PA. However, the study from Quest Diagnostics, one of the leading providers of diagnostic services, suggests that these recommendations may be overly restrictive. Their research indicates that the laboratory cutoffs outlined in the guidelines are only identifying the most advanced cases of primary aldosteronism, which could lead to many individuals remaining undiagnosed and without appropriate treatment.

A Study of Over 60,000 Patients

The researchers involved in the study employed an extensive dataset from over 60,449 patients tested by Quest Diagnostics. They sought to examine how the 2025 diagnostic criteria influenced the identification of primary aldosteronism among the patient cohort. Under these guidelines, 13.0% of the individuals tested positive for PA. In contrast, by utilizing a broader, more flexible set of criteria, the detection rate doubled to approximately 26.2%.

A key point of the research emphasized the inadequate sensitivity of the current guidelines to address early or milder forms of PA, which suggests that PA should be viewed more as a spectrum rather than as a binary diagnosis. Critically, the findings raised concerns that many patients might endure prolonged periods of misdiagnosis, believing their hypertension and related symptoms to be unrelated to a treatable hormonal imbalance.

The Risks of Under-Diagnosis

The implications of missing a primary aldosteronism diagnosis are concerning. The disorder is not only common—affecting up to 5-10% of adults with elevated blood pressure—but also treatable. Failure to diagnose can mean that a substantial percentage of patients could remain at risk for serious cardiac issues, as early intervention can play a vital role in preventing long-term health effects.

Of those identified through the permissive criteria, patients with a low plasma renin activity (PRA < 0.5 ng/mL/hr) exhibited a 1.27-fold greater likelihood of presenting with hypertension compared to patients with higher renin levels. Moreover, 2.62 times higher odds of having associated atrial fibrillation were observed in patients exhibiting a PRA score below 0.25 ng/mL/hr. Alarmingly, 79.0% of additional patients recognized under the relaxed standards had aldosterone levels classified below the guidelines yet manifested clear symptoms indicative of primary aldosteronism.

Moving Forward: A Call to Action

Lead author Dr. Marco Marcelli, an endocrinologist and Medical Director at Quest Diagnostics, highlights the necessity for reevaluating screening practices for primary aldosteronism. The recognition that the current diagnostic criteria may inadvertently overlook milder cases emphasizes the need for the medical community to implement more inclusive screening processes. By expanding diagnostic thresholds, clinicians can better identify patients at risk, allowing for timely treatment and potentially averting severe health consequences.

In conclusion, this study serves as a crucial wake-up call for healthcare professionals to reassess their approach to diagnosing primary aldosteronism. Adopting more flexible criteria could ultimately lead to enhanced health outcomes for individuals affected by this serious yet treatable hormonal disorder. As Quest Diagnostics continues to advocate for better diagnostic solutions, it aligns closely with their broader mission of fostering a healthier world, one life at a time.