{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:10:45Z","timestamp":1792001445419,"version":"4.4.0"},"reference-count":277,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000035","name":"Institute of Nutrition, Metabolism and Diabetes","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000222","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000222","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006510","name":"Duke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006510","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin\u2014biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.<\/jats:p>","DOI":"10.1210\/endrev\/bnad024","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T05:24:42Z","timestamp":1689225882000},"page":"69-94","source":"Crossref","is-referenced-by-count":86,"title":["Biomarkers to Guide Medical Therapy in Primary Aldosteronism"],"prefix":"10.1210","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3559-3531","authenticated-orcid":false,"given":"Gregory L","family":"Hundemer","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Nephrology, University of Ottawa , Ottawa, ON K1H 8L6 ,","place":["Canada"]},{"name":"Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa, ON K1H 8L6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary , Calgary, AB T2N 1N4 ,","place":["Canada"]},{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, AB T2N 1N4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A","family":"Kline","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary , Calgary, AB T2N 1N4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6647-639X","authenticated-orcid":false,"given":"Jenifer M","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina F","family":"Turcu","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology, and Diabetes, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0314-9252","authenticated-orcid":false,"given":"Anand","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"2026041420201024000_bnad024-B1","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/j.2040-4603.2014.tb00569.x","article-title":"The multifaceted mineralocorticoid 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