Adrenal Disease - Hyperaldosteronism

Question 1

What is Primary Hyperaldosteronism?

Answer 1

The adrenal glands are directly responsible for producing too much Aldosterone (serum Renin will be low as it is suppressed by high BP).

Question 2

Aetiology of Primary Hyperaldosteronism (4).

Answer 2

1. Bilateral Idiopathic Adrenal Hyperplasia (commonest).
2. Conn’s Syndrome - Adrenal Adenoma Secreting Aldosterone.
3. Familial Hyperaldosteronism.
4. Adrenal Carcinoma.

Question 3

What is Secondary Hyperaldosteronism?

Answer 3

Excessive Renin stimulates the adrenal glands to produce more Aldosterone (serum Renin will be high).

Question 4

Aetiology of Secondary Hyperaldosteronism (3).

Answer 4

BP in Kidneys is disproportionately lower than BP in Body :

1. Renal Artery Stenosis.
2. Renal Artery Obstruction.
3. Heart Failure.

Question 5

What is Renal Artery Stenosis?

Answer 5

Narrowing of the artery supplying the kidney.

Question 6

What typically causes Renal Artery Stenosis?

Answer 6

Atherosclerosis.

Question 7

Investigations/Diagnosis of Renal Artery Stenosis (3).

Answer 7

1. Doppler US.
2. CT Angiogram.
3. MR Angiography.

Question 8

Management of Renal Artery Stenosis.

Answer 8

Percutaneous Renal Artery Angioplasty via Femoral Artery.

Question 9

Investigations of Hyperaldosteronism (6).

Answer 9

1. Renin/Aldosterone Ratio (Type of Hyperaldosteronism).
2. BP - Hypertension.
3. Serum Electrolytes - Hypokalaemia.
4. ABG - Alkalosis.
5. CT/MRI - Adrenal Tumour.
6. After Ratio, High Resolution CT Abdomen + Adrenal Vein Sampling (Unilateral vs Bilateral).

Question 10

Results of Renin/Aldosterone Ratio (2).

Answer 10

1. Primary = Low Renin - High Aldosterone.

2. Secondary = High Renin - High Aldosterone.

Question 11

How is Hypokalaemia manifested in Primary Hyperaldosteronism?

Answer 11

Muscle Weakness.

Question 12

Clinical Features of Hyperaldosteronism (4).

Answer 12

1. Polyuria.
2. Polydipsia.
3. Lethargy.
4. Headache.

Question 13

Management of Hyperaldosteronism.

Answer 13

1. Aldosterone Antagonists.

2. Treatment of Underlying Cause e.g. Surgical Removal.

Question 14

Examples of Aldosterone Antagonists (2).

Answer 14

1. Eplerenone.

2. Spironolactone.

Question 15

Mechanism of Action of Aldosterone Antagonists.

Answer 15

Potassium-Sparing Diuretics that act in the Cortical Collecting Ducts and Aldosterone Antagonists.

Question 16

Indications of Aldosterone Antagonists (4).

Answer 16

1. Ascites - Secondary Hyperaldosteronism.
2. Heart Failure.
3. Nephrotic Syndrome.
4. Conn’s Syndrome.

Question 17

Adverse Effects of Aldosterone Antagonists (2).

Answer 17

1. Hyperkalaemia.

2. Gynaecomastia (less common with Eplerenone).