Hyperalosteronism

Question 1

What is hyperaldosteronism

Answer 1

Mineralcorticoid excess

Question 2

What are the causes of hyperaldoesteronsim

Answer 2

Excess production by the zona glomerulousa
Conn’s syndrome: an adrenal tumor that increases aldosterone production
Glucorticoid remediable aldosteronism: GRA Aldosterone is regulated by ACTH rather than Renin causing HTN and strokes

Question 3

How does excess in cortisol cause hyperaldoesteronism

Answer 3

Excess cortisol floods mineralcorticoid receptors

Question 4

What are the hallmark s/s of hyperaldosteronism

Answer 4

Hypokalemia
Hypernatremia
Hypertension

Question 5

What are direct effects of increased aldosterone

Answer 5

Increases cardiac remodeling
Decreases compliance
Damage to myocardium
Damage to kidney glomeruli

Question 6

Hyperaldosteronism testing

Answer 6

Plasma renin & aldosterone with aldosterone renin ratio (ARR)
• Positive result if ratio >750 pmol/L per ng/mL per hour w/ concurrent high normal or increased aldosterone
• Serum K+ needs to be normalized
• Stop mineralocorticoid antagonist at least four weeks prior
Normal adrenal morphology & family hx of early onset severe hypertension
• Consider Glucocorticoid remediable aldosteronism (GRA)
• Genetic testing
Urinary steroid metabolite profiling
• Consider for non-aldosterone related mineralocorticoid excess
•Suppressed renin & aldosterone in presence of hypokalemic hypertension
• Increased free cortisol over free cortisone ratio
• Suggestive of syndrome of apparent mineralocorticoid excess (SAME)

Question 7

What imaging can be ordered for hyperaldosteronism

Answer 7

CT of adrenals

Question 8

Medication management for adrenal hyperplasia and GRA

Answer 8

Adrenal hyperplasia: Aldactone , Eplerenone
GRA: Dexamethasone and aldactone