Hyperaldosteronism (3)

Question 1

What is it classically associated with?

What is the primary type known as?
→ What are its causes?

What occurs in the secondary type?
→ What are its causes?

How does it present?

Answer 1

➊ Hypertension that’s resistant to treatment and Hypokalaemia

➋ Conn’s syndrome, where the adrenals produce too much aldosterone, leading to low renin
→ • Bilateral adrenal hyperplasia (70%)
• Adrenal adenoma (30%)

➌ High renin production
→ • Renal artery stenosis
• Renal artery obstruction
• HF

➍ Polyuria, polydipsia, lethargy, headaches

Question 2

What is the main investigation to do?

What are the other investigations to do?

How is it managed?

Answer 2

➊ Aldosterone and Renin
* Renin will be low in primary, and high in secondary

➋ * BP
* U&E - Hypernatraemia, Hypokalaemia
* A/VBG - Metabolic alkalosis
* CT/MRI - Adrenal adenoma
* Renal doppler US, CT/MR Angiogram - Renal artery stenosis

N.B. Hyperatraemia tends to be a much later sign of Conn’s.

➌ * Aldosterone antagonists (e.g. spironolactone, eplerenone) if bilateral hyperplasia
* Surgery if adenoma