Hyperaldosteronism

Question 1

What are the causes of primary hyperaldosteronism?

Answer 1

Adrenal hyperplasia
Adrenal adenoma - Conn’s syndrome
Adrenal carcinoma

Question 2

What are the causes of secondary hyperaldosteronism?

Answer 2

Excessive renin - caused by disproportionately lower blood pressure in the kidneys due to:
- Renal artery stenosis
- Heart failure
- Liver cirrhosis

Question 3

What is the clinical presentation of hyperaldosteronism?

Answer 3

Lethargy
Mood disturbance
Paraesthesia
Muscle cramps
Refractory hypertension

Question 4

What is refractory hypertension?

Answer 4

Where blood pressure remains high despite taking >5 different anti-hypertensives

Question 5

What is the first line diagnostic investigation for hyperaldosteronism?

Answer 5

Aldosterone/renin ratio

Primary hyperaldosteronism
- High aldosterone
- Low renin

Secondary hyperaldosteronism
- High aldosterone
- High renin

Question 6

What other investigations are useful in the diagnosis of hyperaldosteronism?

Answer 6

U&Es - hypokalaemia and hypernatraemia
CT abdomen
Adrenal venous sampling - to determine if there is unilateral or bilateral disease
Renal artery imaging

Question 7

What is the first line management of primary hyperaldosteronism?

Answer 7

For unilateral adrenal hyperplasia or adenoma
- Laparoscopic adrenalectomy
For bilateral adrenal hyperplasia or adenoma
- Spironolactone or eplerenone

Question 8

What is the most common cause of secondary hypertension?

Answer 8

Hyperaldosteronism