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Several recent studies suggest that abnormal adrenal function — in particular, excess secretion of aldosterone and cortisol — are more common than one might expect.
In a large 2020 study (>1000 patients), measurement of 24-hour urine aldosterone levels suggested a much higher prevalence of primary aldosteronism in U.S. patients with hypertension than had been reported previously: The prevalence was 16% in patients with stage 1 hypertension and ≈22% in those with stage 2 or resistant hypertension (NEJM JW Gen Med Jul 1 2020 and Ann Intern Med 2020; 173:10). These findings demonstrated that primary aldosteronism likely has been underdiagnosed using traditional screening with aldosterone–renin ratio (ARR). Underdiagnosis also was suggested in a…