Hypoaldosteronism/Hyperaldosteronism Flashcards
What is the primary function of aldosterone?
Aldosterone promotes the reabsorption of sodium and the
secretion of potassium in the renal tubule.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 925.
How does an excess of aldosterone affect serum
sodium and potassium levels?
An increase in the level of aldosterone can decrease the level of
sodium excreted in the urine significantly. It will also result in
the dramatic loss of potassium into the urine.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 925.
How does a lack of aldosterone affect serum sodium
and potassium levels?
A lack of aldosterone can result in the loss of as much as 10-
20% of the total body’s sodium content per day.
Simultaneously, potassium will be conserved. The total lack of
aldosterone secretion will result in death in as little as three
days.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 924-925.
What is Conn’s syndrome?
Conn’s syndrome is another name for primary
hyperaldosteronism. Primary aldosteronism is characterized by
an excess of aldosterone due to a functional tumor.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397
What is secondary hyperaldosteronism?
Secondary hyperaldosteronism occurs when aldosterone levels
are elevated as a result of increased renin levels.
Renovascular hypertension is a common cause of secondary
hyperaldosteronism.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
What lab findings are associated with
hypoaldosteronism?
Hyperkalemia that occurs in a patient with normal renal function
suggests hypoaldosteronism. Hyponatremia is also present in
these patients.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397-398.
What ventilatory concerns should you have when
anesthetizing a patient with hyperaldosteronism?
Hyperventilation could worsen the hypokalemia associated with
hyperaldosteronism.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
What conditions are associated with primary
hyperaldosteronism?
Hyperaldosteronism may occur with pheochromocytoma,
hyperparathyroidism, and acromegaly.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
What are the signs and symptoms of
hyperaldosteronism?
The symptoms are often nonspecific. Systemic hypertension
from sodium retention may cause headaches. Hypokalemia
may produce polyuria, skeletal muscle weakness, nocturia, and
muscle cramps. It eventually results in a hypokalemic
metabolic alkalosis. Hypomagnesemia and abnormal glucose
tolerance may also be present.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
What signs are suggestive of hyperaldosteronism?
Hypokalemia in the presence of hypertension is suggestive of
hyperaldosteronism (if potassium wasting diuretics are not
being administered).
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
How can a diagnosis of hyperaldosteronism be ruled
out?
An aldosterone level of 9.5 ng/dL after a saline infusion is used
to eliminate hyperaldosteronism as the cause of hypokalemia
and hypertension.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
How can hyperaldosteronism affect the use of
nondepolarizing muscle relaxants?
The hypokalemia associated with hyperaldosteronism can result
in skeletal muscle weakness and potentiation of
nondepolarizing muscle relaxants.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
What is the most common cause of primary
hyperaldosteronism?
The most common cause of primary hyperaldosteronism is
unilateral adenoma in the adrenal gland. About 25% of these
patients, though, may exhibit bilateral adenoma.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 422
What are the cardiac considerations for a patient
with hyperaldosteronism?
Patients with hyperaldosteronism have a high incidence of
ischemic heart disease. A careful preoperative evaluation and
close monitoring during anesthesia should be performed.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 422
How might the presence of hyperaldosteronism
affect your choice of volatile anesthetic?
Hyperaldosteronism can result in hypokalemic nephropathy and
polyuria. In this scenario, the potentially negative effects of
sevoflurane on the kidneys might preclude its use.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 397.
