Hyperaldosteronism Flashcards
what is the most common cause of primary hyperaldosteronism?
bilateral idiopathic hyperaldosteronism (hyperplasia)
what is the 2nd most common cause of primary hyperaldosteronism?
unilateral aldosterone-producing adenoma
what are 3 causes of secondary hyperaldosteronism?
dehydration
CHF
damage to liver + kidneys
what are 3 presenting symptoms of hyperaldosteronism?
hypertension
mild hypernatremia
hypokalemia
what will the hypokalemia in hyperaldosteronism lead to in patients?
muscular weakness
what is the most common cause of resistant hypertension in youth and middle age?
hyperaldosteronism
what is the hallmark of hyperaldosteronism?
HTN + hypokalemia
what will labs look like in primary hyperaldosteronism?
high plasma aldosterone concentration
low plasma renin activity
what PAC:PRA ratio excludes primary aldosteronism?
< 24
what PAC:PRA ratio is suspicious for primary aldosteronism?
24-67
what PAC:PRA ratio is highly suggestive of primary aldosteronism?
> 67
if a patient has a suspicious or suggestive PAC:PRA ratio, what should we order?
24 hour urine collection for aldosterone, free sodium, and creatinine
how does the confirmatory lab for primary aldosteronism work?
give patient 5000 mg Na diet
measure K daily
collect electrolytes and 24 hour urine on 3rd day of diet
what should Na excretion and aldosterone secretion be after the sodium diet, to confirm that the patient has primary hyperaldosteronism?
Na excretion over 4600 mg
aldosterone excretion over 12mcg for 24 hours
what will labs look like in secondary hyperaldosteronism?
high plasma aldosterone concentration
high plasma renin activity
what will the PAC:PRA ratio be in secondary hyperaldosteronism?
less than 10
what imaging should we do if we have a confirmed primary hyperaldosteronism?
and why?
CT scan of adrenal glands
look for adenoma
what can be done to determine unilateral vs bilateral adrenal hyperaldosteronism?
adrenal vein sampling
in which cases is adrenal vein sampling indicated?
in cases of potential surgical intervention
what are 2 differential dx of hyperaldosteronism?
use of diuretics
foods/drinks containing anise
what food/drink can cause hyperaldosteronism? (2)
licorice
sambuca
what is the treatment for bilateral adrenal hyperplasia causing hyperaldosteronism?
spironolactone (aldosterone receptor antagonist)
what are the 2 goals of treating hyperaldosteronism?
normalize K in hypokalemic pts
normalize BP
what are the 2 treatments for unilateral conn syndrome / hyperplasia causing hyperaldosteronism?
laparoscopic complete adrenalectomy
spironolactone
what should we monitor after a laparoscopic complete adrenalectomy when treating unilateral conn syndrome/hyperplasia?
hyperkalemia due to chronic renin release suppression
