Endocrinology - Hyperaldosteronism Flashcards

1
Q

What does angiotensin 2 do?

A

Stimulates the release of aldosterone from the adrenal glands which raises BP

Angiotensin 2 on its own also raises BP

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2
Q

What is the function of Aldosterone?

A

Acts on the kidney to:

  • Increase sodium reabsorption from the distal tubule
  • Increase potassium secretion from the distal tubule
  • Increase hydrogen secretion from the collecting ducts
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3
Q

What is primary hyperaldosteronism?

A

Conn’s syndrome

Adrenal glands produce excess aldosterone

Serum renin is low (as suppressed by high blood pressure)

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4
Q

What are the possible causes of Primary hyperaldosteronism?

A

An adrenal adenoma secreting aldosterone (most common)

Bilateral adrenal hyperplasia

Familial hyperaldosteronism type 1 and type 2 (rare)

Adrenal carcinoma (rare)

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5
Q

What is secondary hyperaldosteronism?

A

Excessive renin stimulating the adrenal glands to produce more aldosterone

Serum renin is high

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6
Q

Causes of secondary hyperaldosteronism

A

When the BP in the kidneys is lower than the BP in the rest of the body

Renal artery stenosis - (cause to remember)
Renal artery obstruction
Heart failure

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7
Q

What is renal artery sclerosis? What causes it? Investigations?

A

Narrowing of the renal artery

Usually due to atherosclerosis

Doppler ultrasound, CTA or MRA

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8
Q

Investigations in suspected hyperaldosteronism

A

Check renin and aldosterone levels

Calculate a renin/aldosterone ratio

BP (hypertension)
Serum electrolytes (hypokalaemia)
Blood gas (alkalosis)

If aldosterone level high, look for cause:

  • CT/MRI to look for adrenal tumour
  • Renal doppler ultrasound or CT angio for renal artery stenosis/obstruction
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9
Q

Management of hyperaldosteronism

A

Aldosterone antagonists:

  • Eplerenone
  • Spironolactone

Treat underlying cause:

  • Surgical removal of adenoma
  • Percutaneous renal artery angioplasty for renal artery stenosis
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10
Q

If a patient is not responding to treatment for suspected essential hypertension…

A

Consider that it may be secondary hypertension

Perform a renin:aldosterone ratio

Hyperaldosteronism is the most common cause of secondary hypertension

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