Primary Hyperaldosteronism Flashcards
What is primary hyperaldosteronism?
It is defined as a condition in which the adrenal glands secretes increased aldosterone levels
Which layer of the adrenal gland secretes aldosterone?
Zona glomerulosa
What is the function of aldosterone?
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
What is the pathophysiological consequence of primary hyperaldosteronism?
It results in increased sodium levels and decreased potassium levels, which ultimately leads to hypertension development
What are the five risk factors of primary hyperladosteronism?
Bilateral Idiopathic Adrenal Hyperplasia
Unilateral Idiopathic Adrenal Hyperplasia
Adrenal Adenoma
Adrenal Carcinoma
Familial Hyperaldosteronism
What is the most common risk factor of primary hyperaldosteronism?
Bilateral Idiopathic Adrenal Hyperplasia
What is the term used to refer to primary hyperaldosteronism related to an adrenal adenoma?
Conn’s syndrome
What are the four clinical features associated with primary hyperaldosteronism?
Refractory Hypertension
Headache
Muscle Weakness
Muscle Cramps
What is the first clinical feature of primary hyperaldosteronism?
Refractory hypertension
What is refractory hypertension?
It is defined as uncontrollable hypertension
How are muscle weakness and cramps associated with primary hyperaldosteronism?
They result as a complication of hypokalaemia
In exams, how does primary hyperaldosteronism tend to present?
It tends to present with hypertension, hypernatraemia and hypokalaemia
What are the four investigations used to diagnose primary hyperaldosteronism?
Blood Pressure Tests
Blood Tests
Abdomen CT Scans
Adrenal Venous Sampling (AVS)
What is a feature of primary hyperaldosteronism on blood pressure tests?
Hypertension
What are the five blood test results indicative of primary hyperaldosteronism?
Increased Aldosterone: Renin > 20
Increased Aldosterone Levels > 500
Decreased Renin Levels < 2.8
Increased Sodium Levels
Decreased Potassium Levels
What is the first line investigation used to diagnose primary hyperaldosteronism?
Aldosterone: Renin
Why are renin levels decreased in primary hyperaldosteronism?
This is due to the neagtive feedback system, in which increased sodium levels inhibits renin production
What diagnosis is indicated when both aldosterone and renin levels are increased?
Secondary hyperaldosteronism
When are abdominal CT scans used to investigate primary hyperaldosteronism?
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
When is adrenal venous sampling used to investigate primary hyperaldosteronism?
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
What is adrenal venous sampling?
It involves drawing blood from both the right and left adrenal veins
How is adrenal venous sampling used to investigate primary hyperaldosteronism?
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
What is the pharmacological management option of primary hyperaldosteronism?
Aldosterone Antagonists
When are aldosterone antagonsists used to manage primary hyperaldosteronism?
They are the first line management option in cases where primary hyperaldosteronism is related to bilateral idiopathic adrenal hyperplasia.
Name two aldosterone antagonsists used to manage primary hyperaldosteronism
Spironolactone
Eplerenone
What is the surgical management option of primary hyperaldosteronism?
Laparoscopic Adrenalectomy
When is laparoscopic adrenalectomy used to manage primary hyperaldosteronism?
It is the first line management option in cases where primary hyperaldosteronism is related to adrenal adenomas
What is laparoscopic adrenalectomy?
It involves laparoscopic removal of the adrenal adenoma
