The Curbsiders Internal Medicine Podcast #515 Primary Aldosteronism, A Deep Dive with Anand Vaidya, MD
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Feb 23, 2026 Anand Vaidya, MD — endocrinologist and adrenal disorders expert at Mass General Brigham and Harvard Medical School. He explains what primary aldosteronism is and why it matters. He reviews who should be screened, practical renin/aldosterone testing strategies, pitfalls from medications and imaging, and evolving localization and treatment options including new imaging and therapies.
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Just Order Renin Aldosterone And Potassium
- When you suspect primary aldosteronism, order renin, aldosterone, and potassium immediately without complex med washouts.
- Testing on typical antihypertensives is acceptable because drug effects often push results toward false negatives, not false positives.
Test Even If Patients Are On BP Meds
- Do not routinely stop antihypertensives to screen; many meds (thiazides, ACEi/ARBs) raise renin and can mask disease but a persistently low renin despite meds confirms PA.
- Reserve washout only for high suspicion with negative initial tests.
Primary Aldosteronism Is A Continuum Not A Binary
- Primary aldosteronism lies on a continuum; any aldosterone production with low renin increases cardiovascular risk.
- Operational cutoffs are pragmatic (aldosterone ~10 ng/dL immunoassay or ~7.5 by mass spec) but not absolute.