Hyperaldosteronism

Question 1

What is primary hyperaldosteronism?

Answer 1

XS production of aldosterone independent of the RAAS ->

• ↑ sodium so water retention (↑ BP)
• ↓ renin

Question 2

What are the causes of primary hyperaldosteronism?

Answer 2

2/3 adrenal adenoma secreting aldosterone (Conn’s syndrome)

1/3 bilateral adrenocortical hyperplasia

Question 3

When should you consider primary hyperaldosteronism?

Answer 3

• HTN
• Hypokalaemia
• Alkalosis
  in someone not on diuretics

Question 4

Explain the pathophysiology underlying primary hyperaldosteronism

Answer 4

Increase in aldosterone leads to increase Na+ and water retention leading to HTN
Increase loss of K+ leading to hypokalaemia

Question 5

How does primary HA present?

Answer 5

Often asymptomatic

1. HTN: so headache, facial flushing, associated w renal, cardiac + retinal damage
2. HYPOKALAEMIA - weakness/cramps, paraesthesia, polyuria + polydipsia, constipation

Question 6

What tests would u do?

Answer 6

1. U&E - hypokalaemia (not always present so don’t rely on)
2. ECG - flat T wave, ST depression, long QT
3. Plasma aldosterone: renin ratio (ARR)

Question 7

What test is diagnostic of primary HA?

Answer 7

Increased plasma aldosterone levels that aren’t suppressed w 0.9% saline infusion or fludrocortisone administration (mineralocorticoid)

Question 8

What are the four main features of hyperaldosteronism?

Answer 8

1. Hypernatraemia
2. Hypokalaemia
3. Hypertension
4. Metabolic alkalosis

Question 9

How would u differentiate between primary and secondary hyperaldosteronism?

Answer 9

Primary will have high levels of aldosterone and low levels of renin as aldosterone inhibits the production of renin
Secondary - high aldosterone and high renin

Question 10

What is the difference between primary and secondary?

Answer 10

primary is caused by a problem with the adrenal cortex producing too much aldosterone
Secondary - extra adrenal causes of aldosterone e.g. increased renin

Question 11

What part of the adrenal gland secretes aldosterone?

Answer 11

Zona glomerulosa

Question 12

What are the causes of secondary HA?

Answer 12

• Chronic low BP: CCF, Cirrhosis
• Diuretics
• Reduced renal perfusion e.g. renal artery stenosis

Question 13

What is the treatment of Conns?

Answer 13

Laparoscopic adrenalectomy

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

Question 14

What is the treatment of adrenal hyperplasia causing HA?

Answer 14

Medical w spironolactone