Hyperaldosteronism

Question 1

what is hyperaldosteronism

Answer 1

overproduction of aldosterone

Question 2

describe primary hyperaldosteronism

Answer 2

• Conn syndrome
• originally thought to be caused by adrenal adenomas
• 70% cases due to bilateral adrenal hyperplasia

Question 3

describe secondary hyperaldosteronism

Answer 3

• result of overproduction of renin
• causes RAAS system overactivity
• e.g. due to renin producing tumour or renal ischaemia

Question 4

what are some presentations of hyperaldosteronism

Answer 4

• hypernatraemia
• hypokalaemia (some cases K+ levels normal)
• hypertension
• muscle cramps
• headache
• lethargy

Question 5

what investigations can be done in suspected hyperaldosteronism

Answer 5

• U&E:
• -> ↑Na+
• -> ↓K+
• -> alkalosis (↓H+)
• obtain aldosterone:renin ratios
• ECG may demonstrate electrolyte abnormalities
• CT adrenal glands

Question 6

how can you differentiate between primary and secondary hyperaldosteronism

Answer 6

primary = ↑aldosterone, ↓renin
secondary = normal aldosterone:renin ratio

Question 7

outline the management strategies for hyperaldosteronism

Answer 7

conn syndrom (primary):

• adrenalectomy is first line and definitive
• if cause is bilateral adrenal hyperplasia, medical treatment is first line; aldosterone antagonists
• -> spironolactone, eplerenone, amiloride

secondary:
- treat underlying cause