Jes Pa Screening Indication

---
name: jes-pa-screening-indication
description: Determines whether a hypertensive patient should be screened for primary aldosteronism based on clinical features associated with higher PA prevalence. Triggered when a clinician asks 'Should I screen this hypertensive patient for PA?' or observes spontaneous hypokalemia, resistant hypertension, hypertension onset before age 40, adrenal tumor, young-onset stroke, or sleep apnea syndrome.
---

# Determine when to screen for primary aldosteronism in hypertensive patients

## STEP 1 — Gather Information
Confirm hypertension diagnosis and collect: serum potassium (spontaneous hypokalemia?), blood pressure readings and medication count (resistant hypertension?), age at hypertension onset, imaging for adrenal tumor, history of stroke before age 40, and sleep apnea evaluation.

## STEP 2 — Rule In / Rule Out
Is the patient hypertensive? If no → do not screen for PA; if yes → proceed to assess for high-prevalence features.

## STEP 3 — Classify or Stratify
Does the hypertensive patient have any of: spontaneous hypokalemia, resistant hypertension, hypertension onset before 40 years, adrenal tumor on imaging, stroke at a young age, or sleep apnea syndrome? If yes → classify as high suspicion; if no → classify as routine suspicion.

## STEP 4 — Decide
High suspicion → screen for PA promptly (e.g., ARR ≥200 with PAC ≥60 pg/mL). Routine suspicion → screen for PA as part of standard hypertension evaluation per guideline recommendation.

## Clinical Guardrails / Mimics / Pitfalls
Do not rely solely on hypokalemia to exclude PA; many PA patients have normal potassium. Avoid screening in normotensive individuals unless secondary hypertension is suspected. Do not delay screening in patients with resistant hypertension or adrenal incidentaloma.

## Concrete Clinical Example
A 45‑year‑old with hypertension on three medications, BP 158/96 mmHg, and incidental 1.2 cm adrenal nodule on abdominal CT is identified as high suspicion (adrenal tumor + resistant hypertension) and undergoes ARR screening.

**Source:** Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2021.