Hyperaldosteronism

Question 1

What is primary hyperaldosteronism?

Answer 1

Production of aldosterone outside of the RAAS system causing salt and water retention and a decreased renin release

Question 2

When would a diagnosis of primary hyperaldosteronism be considered?

Answer 2

When there is hypokalaemia, hypertension or alkalosis in someone not on diuretics. Sodium may be normal or slightly raised

Question 3

What are the symptoms of primary hyperaldosteronism?

Answer 3

Asymptomatic
Symptoms of hypokalaemia
Weakness, paraesthesia, cramps
Polyuria, polydipsia

Question 4

What are the causes of primary hyperaldosteronism?

Answer 4

2/3 - Conn’s syndrome
- solitary aldosterone-producing adenoma
1/3 - bilateral adrenocortical hyperplasia

Rare: adrenal carcinoma, GRA

Question 5

What tests are used to investigate primary hyperaldosteronism?

Answer 5

U&Es
Renin and aldosterone
- high aldosterone and low renin
Adrenal vein sampling
Genetic testing if suspecting GRA
CT/MRI of the adrenals (one ever hyperaldosteronism is proven)
- localises cause

Question 6

In what situations is Conns suspected?

Answer 6

Hypertension with hypokalaemia
Hypertension refractory to 3+ drugs
Hypertension before age 40, esp. in women

Question 7

What is the treatment for Conns syndrome?

Answer 7

Laparoscopic adrenalectomy

Spironolactone 4 weeks pre-op to control BP and K+

Question 8

What is the treatment for adrenocortical hyperplasia?

Answer 8

Spironolactone and amiloride

Question 9

What is the treatment for adrenal carcinoma?

Answer 9

Surgery +/- post-surgery adrenolytics e.g. mitotane

Question 10

What is secondary hyperaldosteronism?

Answer 10

Increased renal production due to underperfused kidneys e.g. renal artery stenosis, hepatic failure, CCF, diuretics etc.