It is now 25 years since Conn1 first described an aldosteronesecreting adrenal adenoma that manifested itself clinically by hypertension and hypokalemia. Since that time the nature of primary aldosteronism, its subdivisions, and its therapy have been reasonably well defined. The early exaggerated estimate of its prevalence has been slashed from 20% of hypertensive patients to less than 2%, and the prevalence of surgically curable aldosteronism to much less than that.
In view of the relative rarity of primary aldosteronism and the cost in terms of time and money entailed in its diagnosis, most clinicians do not screen their hypertensive patients for aldosteronism unless it is strongly suspected.
Streeten et al2 take issue with this conservative approach. Even though the prevalence of primary aldosteronism in their series of 1,036 consecutive referred hypertensive patients was only 2.2% and that of aldosterone-secreting adenomas was only 0.5%, they make a plea for