Primary Aldosteronism

Question 1

What is PA?

Answer 1

Autonomous production of aldosterone independent of its regulators (angiotensin II/Potassium)

Question 2

What is PA the commonest secondary cause of?

Answer 2

Hypertension

Question 3

Epidemiology of PA/causes?

Answer 3

• Can be familial

- Can be due to somatic mutations leading to loss of ion selectivity

Question 4

What does aldosterone do?

Answer 4

• Increases sympathetic outflow
• Alters endothelial function increasing pressor response
• Increased cardiac collagen
• Cytokines and RAS synthesis
• Sodium retention

Question 5

Subtypes/causes of primary aldosteronism?

Answer 5

Adrenal adenoma 
Bilateral adrenal hyperplasia 
Rare causes: 
-Genetic mutations 
-Unilateral hyperplasia

Question 6

Commonest cause of PA?

Answer 6

Bilateral adrenal hyperplasia

Question 7

What is the subtype of PA called caused by adrenal adenoma?

Answer 7

Conn’s syndrome

Question 8

Presentation of primary aldosteronism?

Answer 8

• Significant hypertension
• Hypokalaemia
• Alkalosis

Question 9

How to confirm aldosterone XS (long version)?

Answer 9

-Measure plasma aldosterone and renin and express as ratio (ARR- aldosterone to renin ratio)

If ratio is raised then investigate further with saline suppression test

Failure of plasma aldosterone to suppress by >50% with 2 litres of normal saline confirms PA

Question 10

How to confirm subtype of PA?

Answer 10

• Adrenal CT- adenoma

- Sometimes adrenal vein sampling to confirm adenoma is true source

Question 11

Confirming aldosterone XS bullet points?

Answer 11

-Measure plasma aldosterone and renin and express as ratio
|
If raised do saline suppression test
|
If it doesn’t suppress by >50% with 2 litres saline = PA

Question 12

Management of PA?

Answer 12

• Unilateral laparoscopic adrenalectomy (only if adrenal adenoma) = surgical
• Use MR antagonists in bilateral hyperplasia (spironolactone or eplerenone) = Medical