Are We Only Detecting the Tip of the Iceberg? A Nationwide Study on Primary Aldosteronism with up to 8-Year Follow-up.

Background: Long-term follow-up studies on primary aldosteronism (PA) are lacking.

Objective: We aim to review results of diagnostic procedures and histopathology for patients diagnosed during 2012-2016 in Iceland, compare unilateral (UD) and bilateral disease (BD) and assess treatment response.

Methods: Thirty-two patients aged 28-88 were diagnosed and treated according to guidelines.

Results: The majority had BD. Everyone needed potassium supplementation at case detection. We saw a reduction in systolic blood pressure ( < .001, both groups), antihypertensive agents ( = .002 UD and = .04 BD) and potassium supplementation ( < .001, both groups).

Conclusion: Similar treatment response was seen in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland.