2: Hyperaldosteronism (Conns Syndrome) Flashcards
What is hyperaldosteronism
excess secretion of aldosterone from the adrenal gland
What is the most common cause of secondary HTN
hyperaldosteronism
what are the two types of hyperaldosteronism
- Primary hyperaldosteronism
- Secondary hyperaldosteronism
what are 3 causes of primary hyperaldosteronism
- Solitary adrenal adenoma (Conns Syndrome)
- Adrenal carcinoma
- Bilateral adrenal hyperplasia
what is a solitary aldosterone producing adenoma called
Conn’s syndrome
what causes a 1/3 of hyperaldosteronism
Bilateral adrenal hyperplasia
what is secondary hyperaldosteronism
high aldosterone due to excess renin secretion
what are 5 causes of secondary hyperaldosteronism
- Renal-artery stenosis
- Accelerated HTN
- Diuretics
- CCF
- Hepatic Failure
What is barter’s syndrome
AR Disorder causing congenital salt-wasting
What mutation is present in Barter’s syndrome
Mutation in sodium chloride channels in ascending loop of Henley causing excretion and loss of water
How does barter’s syndrome present
FTT
Polyuria
Polydipsia
Normotensive
What is the distinguishing feature about Barter’s syndrome
Blood pressure will be normal
Explain pathophysiology and metabolic abnormalities in Barter’s syndrome
Excretion of Na+ and Cl-. To try and retain sodium there is hyper-activation of Na+-K+ ATPase which causes hypokalaemia and metabolic alkalosis
How does hyperaldosteronism present clinically
- Asymptomatic
- Secondary HTN
What electrolyte abnormality is present in hyperaldosteronism
Hypoakalaemia
How may hypokalaemia present clinically
Weakness Arrhythmias Fatigue Headache Palpitations
What is first-line investigation for Hyperaldosteronism
Aldosterone:renin ratio
What does a high aldosterone to renin ratio indicate
Primary hyperaldosteronism
Explain high aldosterone: renin in primary hyperaldosteronism
- Excess aldosterone secretion by adrenal glands
- High aldosterone negatively feedback to cause low renin
If high aldosterone:renin ratio what investigation is ordered
CT Abdomen
Adrenal Vein Sampling
What is HR-CT abdomen and adrenal vein sampling ordered for
Distinguish solitary adenoma (Conns) from bilateral adrenal hyperplasia
What test is sometimes used in primary hyperaldosteronism
Saline Infusion Test
Explain saline infusion test
Give 2L Saline over 4h
In a health individual this will suppress RAAS system. In primary hyperaldosteronism - aldosterone will remain high
How is bilateral adrenal hyperplasia managed
Spironolactone (Aldosterone antagonist)
