Hyperaldosteronism

Question 1

Specialised cells in afferent arteriole of kidney?

Answer 1

Juxtaglomerular cells

Question 2

Role of juxtaglomerular cells?

Answer 2

Sense BP in these vessels, when it senses low BP they secrete renin hormone

Question 3

What happens when juxtaglomerular cells secrete renin hormone?

Answer 3

Liver secretes protein called angiotensinogen

Question 4

What happens to angiotensinogen?

Answer 4

Renin converts it to angiotensin 1

Question 5

What happens to angiotensin 1?

Answer 5

ACE converts it to angiotensin II (lungs)

Question 6

What is role of angiotensin II?

Answer 6

Stimulates release of aldosterone

Question 7

What is aldosterone?

Answer 7

Mineralocorticoid

Question 8

What does aldosterone act on?

Answer 8

The kidney

Question 9

What does aldosterone cause to occur when it acts on kidney?

Answer 9

• Increased Na+ reabsorption form distal tubule
• Increased K+ secretion from distal tubule
• Increased H+ secretion from CDs

Question 10

What is hyperaldosteronism AKA?

Answer 10

Conn’s syndrome

Question 11

What is Conn’s syndrome?

Answer 11

When adrenal glands are directly responsible to producing too much aldosterone

Question 12

What will serum renin be like in primary hyperaldosteronism?

Answer 12

LOW serum renin as suppressed by high BP, several possible reasons for this

Question 13

Possible reasons for high BP causing Conn’s syndrome?

Answer 13

• Adrenal adenoma secreting aldosterone (common)
• Bilateral adrenal hyperplasia
• Familial hyperaldosteronism type 1 & type 2 (rare)
• Adrenal carcinoma (rare)

Question 14

What is secondary hyperaldosteronism?

Answer 14

Where XSive renin stimulates adrenal glands to produce more aldosterone

Serum renin will be high

Question 15

Causes of high renin levels?

Answer 15

Renal artery stenosis
Renal artery obstruction
Heart failure

Question 16

What generally causes high renin levels?

Answer 16

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

Question 17

Investigations for hyperaldosteronism?

Answer 17

-Check renin & aldosterone levels & calculate a renin:aldosterone ratio

Question 18

What does high aldosterone and low renin signify?

Answer 18

Primary hyperaldosteronism

Question 19

What does high aldosterone and high renin signify?

Answer 19

Secondary hyperaldosteronism

Question 20

Other investigations for aldosterone?

Answer 20

BP
Serum electrolytes (hypo K+)
Blood gas analysis (alkalosis)

Question 21

Investigating for cause of high renin?

Answer 21

• CT or MRI

- Renal doppler US, CT angiogram or MPA

Question 22

Management of hyperaldosteronism?

Answer 22

• Eplerenone

- Spironolactone

Question 23

Treating underlying cause of hyperaldosteronism?

Answer 23

• Surgical removal of adenoma

- Percutaneous renal artery angioplasty via femoral artery to treat renal artery stenosis

Question 24

Presnetation of hyperaldosteronim?

Answer 24

High blood pressure.
Low level of potassium in the blood.
Feeling tired all the time.
Headache.
Muscle weakness.
Numbness