Hyperaldosteronism Flashcards
what is primary
excess production aldosterone independent of RAAS
what does primary cause
incr sodium and water retention, decr renin release
when would you consider primary
hypertension, hypokalaemia, alkalosis
symptoms primary
asymptomatic or signs of hypokalaemia- weakness, cramps, paraesthesiae, polyuria, polydipsia. bp incr but not always
causes
2/3- solitary aldosterone producing adenoma (Conns). 1/3 due to bilateral adrenocortical hyperplasia
what is GRA
glucorticoid remediable aldosteronism
tests
U&E, renin and aldosterone (not on diuretics, hypotensives, steroids, K+ or laxatives)
what is Conns
solitary aldosterone secreting adenoma
treatment of Conns
lap adrenalectomy. spironolocatone
treatment hyperplasia, GRA, adrenal carcinoma
hyperplasia- spironolactone, amiloride, eplerenone. GRA- dexamethasone. adrenal carcinoma- surgery +- post op adrenolytic therapy
what is secondary
due to high renin from renal underperfusion eg in renal artery stenosis, accelerated hypertension, diuretics, CCF or hepatic failure.
what is Bartters syndrome
major cause congenital salt wasting- sodium and chloride leak in loop of Henle- defective channel. in childhood presents failure to thrive, polyuria, polydipsia. bp normal
treatment in Bartters syndrome
K+ replacement, NSAIDS, ACEi
when should you consider Conns
1) hypertension associated with hypokalaemia. 2) refractory hypertension despite 3 or more antihypertensives. 3) hypertension before 40 years of age.
what is a more common cause of refractory incr in bp and decr in K+ (compared to Conns)
renal artery stenosis
