Primary hyperaldosteronism

Question 1

Primary hyperaldosteronism caused by ?

Answer 1

bilateral idiopathic adrenal hyperplasia

adrenal adenoma: 20-30% of cases

unilateral hyperplasia

Question 2

Primary hyperaldosteronism features ?

Answer 2

hypertension

hypokalaemia

metabolic alkalosis

Question 3

initial Investigations of Primary hyperaldosteronism features ?

Answer 3

Plasma aldosterone/renin ratio is the first-line investigation in suspected primary hyperaldosteronism.

Should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)

Question 4

following aldosterone / renin ratio

Answer 4

high-resolution CT abdomen and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess

if the CT is normal adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia

Question 5

Management

Answer 5

adrenal adenoma: surgery (laparoscopic adrenalectomy)

bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone