Hyperaldosteronism

Question 1

Define Primary Hyperaldosteronism

Answer 1

Excess aldosterone, independent of RAS

Question 2

Features

Answer 2

Hypokalaemia: weakness, hypotonia, hyporeflexia, cramps
Paraesthesia
↑BP

Question 3

Causes (2)

Answer 3

Bilateral adrenal hyperplasia (70%)
  Adrenocortical adenoma (30%): Conn’s syndrome

Question 4

Investigations

Answer 4

U+E: ↑/ Na, ↓K, alkalosis
Care ̄c diuretics, hypotensives, laxatives, steroids
Aldosterone:renin ratio: ↑ ̄c primary
ECG: flat / inverted T waves, U waves, depressed ST
segments, prolonged PR and QT intervals
Adrenal CT/MRI

Question 5

Treatment

Answer 5

Conn’s: laparoscopic adrenelectomy

Hyperplasia: spironolactone, eplerenone or amiloride

Question 6

Define secondary Hyperaldosteronism

Answer 6

Due to ↑ renin from ↓ renal perfusion

Question 7

Causes

Answer 7

RAS
  Diuretics
  CCF
  Hepatic failure
  Nephrotic syndrome

Question 8

Investigation

Answer 8

Aldosterone:renin ratio: normal

Question 9

What is Bartter’s syndrome

Answer 9

Bartter’s Syndrome
Autosommal recessive
Seen with sensorineural loss
Blockage of NKCC2 reabsorption in loop of Henle (as if
taking frusemide)
Congenital salt wasting → RAS activation →
hypokalaemia and metabolic alkalosis Normal BP
High calcium
Low Mg2+