Update of TAIPAI

Vincent WuTaiwan Speaker From Taiwan to the World: The TAIPAI Journey Transforming Primary AldosteronismPrimary aldosteronism (PA) is an increasingly recognized cause of secondary hypertension, affecting an estimated 5%-15% of hypertensive patients. This condition, once thought to be rare, is now understood to be a relatively common contributor to high blood pressure, particularly in cases resistant to standard antihypertensive therapies. PA arises primarily from either bilateral adrenal hyperplasia or an aldosterone-producing adenoma. The pathophysiology of PA is characterized by excessive and autonomous secretion of aldosterone, an adrenal hormone that plays a critical role in regulating blood pressure and fluid balance. Diagnosing PA involves a multi-step process, beginning with screening tests to identify at-risk individuals, followed by confirmatory tests, and finally, subtype differentiation to determine the specific cause of the condition. Screening is especially recommended for patients who present with certain risk factors, such as resistant hypertension, unexplained hypokalemia, or an onset of hypertension at a young age (under 40 years). Family history of PA, early signs of target organ damage, the presence of an adrenal incidentaloma, obstructive sleep apnea, unexplained atrial fibrillation, and psychosomatic symptoms are also significant indicators warranting screening. Additionally, patients with hypertension but no other comorbidities should be evaluated for PA, as it could be the underlying cause. PA does not occur in isolation; it is often found to coexist with Mild Autonomous Cortisol Secretion (MACS). This co-occurrence presents a more complex clinical picture, as MACS can further aggravate the cardio-renal-vascular complications already associated with PA. Moreover, it can contribute to abnormalities in glucose metabolism, increasing the risk of diabetes and other metabolic disorders. One of the key challenges in the diagnosis and management of PA, particularly when MACS is present, lies in accurately interpreting the aldosterone-to-cortisol ratios during adrenal venous sampling, a critical step in subtype differentiation.