Hyperaldosteronism

Question 1

What is primary hyperaldosteronism?

Answer 1

Excess production of aldosterone, independent of renin-angiotensin system causing sodium and water retention and reduced renin release.

Question 2

When should you consider primary hyperaldosteronism?

Answer 2

Hypertension, hypokalaemia or alkalosis in someone who is not on diuretics.
Sodium tends to be mildly raised or normal.

Question 3

What are symptoms of primary hyperaldosteronism?

Answer 3

Often asymptomatic or signs of hypokalaemia: weakness, craps, paraesthesiae, polyuria, polydipsia.
Hypertension but not always

Question 4

What are causes of primary hyperaldosteronism?

Answer 4

Conn’s syndrome - aldosterone-producing adenoma of the adrenal cortex
Bilateral adrenocortical hyperplasia

Question 5

What test for primary hyperaldosteronism?

Answer 5

Plasma renin:aldosterone ratio low - suppressed renin and raised aldosterone indicates Conn’s
U&E
Adrenal vein sampling.
CT/MRI of adrenals to localise cause.

Question 6

What is treatment for Conn’s syndrome?

Answer 6

Laparoscopic adrenalectomy Spironolactone for 4 wks pre-op controls BP and potassium.

Question 7

What is the treatment for bilateral adrenocortical hyperplasia?

Answer 7

Spironolactone or amiloride

Question 8

What is secondary hyperaldosteronism?

Answer 8

Due to a high renin form reduced renal perfusion e.g. in renal artery stenosis, accelerated hypertension, diuretics, CCF or hepatic failure

Question 9

What is Bartter’s syndrome?

Answer 9

Congenital salt eating - NaCl leak in LOH via mutations.
Sodium loss leads to volume depletion causing increased renin and aldosterone production, leading to hypokalaemia and metabolic alkalosis.

Treat with K replacement, NSAIDs to inhibit prostaglandins, and ACEi

Question 10

When should you think of Conn’s syndrome?

Answer 10

Hypertension associated with hypokalaemia
Refractory hypertension (e.g. despite 3 or more drugs)
Hypertension occurring before 40 years of age (especially in women)