Primary Hyperaldosteronism

Question 1

What is primary hyperaldosteronism?

Answer 1

It is defined as a condition in which the adrenal glands secretes increased aldosterone levels

Question 2

Which layer of the adrenal gland secretes aldosterone?

Answer 2

Zona glomerulosa

Question 3

What is the function of aldosterone?

Answer 3

It is a hormone involved in the regulation of sodium and potassium levels within the blood

It is involves in sodium absorption and potassium excretion

Question 4

What is the pathophysiological consequence of primary hyperaldosteronism?

Answer 4

It results in increased sodium levels and decreased potassium levels, which ultimately leads to hypertension development

Question 5

What are the five risk factors of primary hyperladosteronism?

Answer 5

Bilateral Idiopathic Adrenal Hyperplasia

Unilateral Idiopathic Adrenal Hyperplasia

Adrenal Adenoma

Adrenal Carcinoma

Familial Hyperaldosteronism

Question 6

What is the most common risk factor of primary hyperaldosteronism?

Answer 6

Bilateral Idiopathic Adrenal Hyperplasia

Question 7

What is the term used to refer to primary hyperaldosteronism related to an adrenal adenoma?

Answer 7

Conn’s syndrome

Question 8

What are the four clinical features associated with primary hyperaldosteronism?

Answer 8

Refractory Hypertension

Headache

Muscle Weakness

Muscle Cramps

Question 9

What is the first clinical feature of primary hyperaldosteronism?

Answer 9

Refractory hypertension

Question 10

What is refractory hypertension?

Answer 10

It is defined as uncontrollable hypertension

Question 11

How are muscle weakness and cramps associated with primary hyperaldosteronism?

Answer 11

They result as a complication of hypokalaemia

Question 12

In exams, how does primary hyperaldosteronism tend to present?

Answer 12

It tends to present with hypertension, hypernatraemia and hypokalaemia

Question 13

What are the four investigations used to diagnose primary hyperaldosteronism?

Answer 13

Blood Pressure Tests

Blood Tests

Abdomen CT Scans

Adrenal Venous Sampling (AVS)

Question 14

What is a feature of primary hyperaldosteronism on blood pressure tests?

Answer 14

Hypertension

Question 15

What are the five blood test results indicative of primary hyperaldosteronism?

Answer 15

Increased Aldosterone: Renin > 20

Increased Aldosterone Levels > 500

Decreased Renin Levels < 2.8

Increased Sodium Levels

Decreased Potassium Levels

Question 16

What is the first line investigation used to diagnose primary hyperaldosteronism?

Answer 16

Aldosterone: Renin

Question 17

Why are renin levels decreased in primary hyperaldosteronism?

Answer 17

This is due to the neagtive feedback system, in which increased sodium levels inhibits renin production

Question 18

What diagnosis is indicated when both aldosterone and renin levels are increased?

Answer 18

Secondary hyperaldosteronism

Question 19

When are abdominal CT scans used to investigate primary hyperaldosteronism?

Answer 19

It is the first line investigation used to detect the underlying pathology of primary hyperaldosteronism, specifically detecting whether the aldosterone excess is unilateral or bilateral

Question 20

When is adrenal venous sampling used to investigate primary hyperaldosteronism?

Answer 20

It is the second line investigation used to detect the underlying pathology of primary hyperaldosteronism, specifically detecting whether the aldosterone excess is unilateral or bilateral

It is recommended in cases which CT scans are deemed as normal and plasma:aldosterone levels are positive

Question 21

What is adrenal venous sampling?

Answer 21

It involves drawing blood from both the right and left adrenal veins

Question 22

How is adrenal venous sampling used to investigate primary hyperaldosteronism?

Answer 22

In cases where one vein produces increased aldosterone levels, a unilateral cause of primary hyperaldosteronism is indicated

In cases where both veins produces increased aldosterone levels, a bilateral cause of primary hyperaldosteronism is indicated

Question 23

What is the pharmacological management option of primary hyperaldosteronism?

Answer 23

Aldosterone Antagonists

Question 24

When are aldosterone antagonsists used to manage primary hyperaldosteronism?

Answer 24

They are the first line management option in cases where primary hyperaldosteronism is related to bilateral idiopathic adrenal hyperplasia.

Question 25

Name two aldosterone antagonsists used to manage primary hyperaldosteronism

Answer 25

Spironolactone

Eplerenone

Question 26

What is the surgical management option of primary hyperaldosteronism?

Answer 26

Laparoscopic Adrenalectomy

Question 27

When is laparoscopic adrenalectomy used to manage primary hyperaldosteronism?

Answer 27

It is the first line management option in cases where primary hyperaldosteronism is related to adrenal adenomas

Question 28

What is laparoscopic adrenalectomy?

Answer 28

It involves laparoscopic removal of the adrenal adenoma