Primary Aldosteronism

Question 1

What is primary aldosteronism?

Answer 1

autonomous production of aldosterone by the adrenals independant of its regulators

Question 2

What can primary aldosteronism cause?

Answer 2

secondary hypertension

Question 3

What are the symptoms of primary aldosteronism?

Answer 3

significant hypertension
hypokalaemia 
muscles weakness
headache
alkalosis 
muscle cramps
fatigue

Question 4

What are the 3 subtypes of primary aldosteronism?

Answer 4

bilateral adrenal hyperplasia
conns syndrome - adrenal adenoma
genetic mutations

Question 5

What genetic mutations can lead to adrenal adenomas?

Answer 5

K channel mutations- esp of the KCNJS which is a rectifying selective channel which maintain the membrane potential and hyperpolarisation

Question 6

How is PA diagnosed first?

Answer 6

ratio of aldosterone:renin is measured

if aldosterone is raised: do a saline suppression test

Question 7

What results of a saline suppression test confirms PA?

Answer 7

failure of aldosterone to suppress by >50% with 2 litres of saline

Question 8

What is done after PA is confirmed?

Answer 8

CT of adrenals to confirm the diagnosis

can do vein sampling to confirm that the adenoma is the source

Question 9

How is PA managed?

Answer 9

using a MR antagonist e.g. spironolactone or eplerone in bilateral adrenal hyperplasia
in adrenal adenoma: unilateral laprascopic adrenalectomy