Adrenal gland: Hyperaldosteronism

Question 1

Define primary hyperaldosteronism?

Answer 1

refers to the adrenal glands are directly responsible for producing too much aldosterone.

Renin would be low.

Question 2

Define Hyperaldosteronism?

Answer 2

Overproduction of aldosterone hormone by the adrenal glands.

Question 3

Define secondary hyperaldosteronism?

Answer 3

Refers to excessive renin stimulating the release of excessive aldosterone.

High renin.

Question 4

Causes of primary hyperaldosteronism?

Answer 4

• adrenal adenoma producing too much aldosterone -Conn’s syndrome
• adrenal hyperplasia
• adrenal carcinoma

Question 5

Causes of secondary hyperaldosteronism?

Answer 5

Excessive renin is released due to disproportionate low BP in the kidneys, which could be due to:
- renal artery stenosis (narrowing of the artery supplying the kidney due to atherosclerosis)
- heart failure
- liver cirrhosis
- ascites

Question 6

Presentation of hyperaldosternoism?

Answer 6

• asymptomatic
• hypokalaemia (muscle weakness, fatigue, headache)
• hypernatraemia (high sodium levels; volume retention → hypertension)
• polyuria
• polydipsia

Question 7

Diagnosis/IVx of hyperaldosternoism?

Answer 7

• 24hr urinary aldosterone
• CT or MRI -adrenal tumour, adrenal hyperplasia
• doppler, CT angiogram or MR angiography -renal artery imaging for renal artery stenosis
• bloods -high aldosterone, low potassium

Question 8

Management of hyperaldosternoism?

Answer 8

Medical:
- eplerenone
- spironolactone

Surgical:
- adrenalectomy
- Percutaneous renal artery angioplastyvia the femoral artery to treatrenal artery stenosis