hyperaldosteronism Flashcards
hyperadosteronism vs Conn’s
hyperaldosteronism = high levels of aldosterone
Conn’s = adrenal adenoma producing too much aldosterone
present in 5-10% of patients with hypertension
hypertension = key feature
commonest cause of hyperaldosteronism
bilateral idiopathic adrenal hyperplasia
causes of primary hyperaldosteronism
- bilateral idiopathic adrenal hyperplasia (60-70%)
- adrenal adenoma (20-30%) - conn’s
- familial hyperaldosteronism
- adrenal carcinoma
hyperaldosteronism presentation
hypertension !!
hypokalaemia
- muscle weakness
metabolic alkalosis
hyperaldosteronism investigation
1st line = aldosterone/renin ratio
–> high aldo, low renin (high BP suppresses renin)
CT abdo
- if CT normal -> adrenal venous sampling (AVS) (blood from both sides, see which is producing more)
–> distinguish between unilateral adenoma + bilateral hyperplasia
renal artery imaging -> for stenosis
which patients should be screened for primary hyperaldosteronism
hypertension with hypOkalaemia
–> Cushing also presents like this
treatment resistant hypertension
management of primary hyperaldosteronism
adrenal adenoma - laparoscopic adrenalectomy
bilateral adrenocortical hyperplasia –> aldosterone antagonist - spirnolactone, eplerenone
renal artery stenosis - percutaneous angioplasty
secondary hyperaldosteronism
caused by excessive renin stimulating the release of excessive aldosterone
causes of secondary hyperaldosteronism
excessive renin is released due to disproportionately lower blood pressure in the kidneys, usually due to -
- renal artery stenosis - atherosclerosis
- heart failure
- liver cirrhosis
commonest cause of secondary hypertension
hyperaldosteronism
- test in patients with hypertension who are younger, fail to respond to treatment or have low potassium
(potassium levels can be normal)
