Hyperaldosteronism Flashcards
What are the causes of secondary hypertension?
Most common = primary hyperaldosteronism.
Other endocrine causes: Phaeochromocytoma, Cushing’s syndrome, CAH, acromegaly
Drug causes: Steroids, COCP, NSAID
Other: Prenancy, coaractation of the aorta, renal disease (second most common cause)
What is hyperaldosteronism?
Excess aldosterone which can cause resistant hypertension and low serum potassium
What are the causes of primary hyperaldosteronism?
- Adrenal adenoma (Conn’s Syndrome)
- Bilateral adrenal hyperplasia (most common cause)
- Familial hyperaldosteronism
- Adrenal carcinoma
What are the biochemical features of hyperaldosteronism?
Hypertension
Hypokalaemia
Metabolic alkalosis
What are the clinical features of hyperaldosteronism?
Polyuria
Polydipsia
Lethargy
Headaches
Hypertension
What are the investigations for hyperaldosteronism?
Aldosterone-renin ration (first line) - high aldosterone and low renin
CT/MRI
FBC/UEs/LFT
ESR
Bone profile
TFTs
Chest X -ray
ECG
Selective adrenal venous sampling
What are the portential results from the aldosterone renin ration?
- High aldosterone and low renin = primary hyperaldosteronism
- High aldosterone and high renin = secondary hyperaldosteronism
What is the management for hyperaldosteronism?
- Aldosterone antagonists such as spironolactone or eplerenone (used in adrenal hyperplasia).
- Treat underlying cause resection of adrenal adenoma or percutaneous renal artery angioplasty.
What is secondary hyperaldosteronism?
Excess renin. Causes include: Low renal BP (renal artery stenosis, renal artery obstruction or HF)
What are the causes of secondary hyperaldosteronism?
Occurs due to excessive renin. This occurs when the BP is low in the kidneys:
- Renal artery stenosis,
- Heart failure,
- Liver cirrhosis
What are the investigations for renal artery stenosis?
- Doppler ultrasound,
- CT angiogram
- Magnetic resonance angiograohy
