Primary Hyperaldosteronism

Question 1

What is the most common cause of Primary Hyperaldosteronism?

Answer 1

Bilateral idiopathic adrenal hyperplasia (MOST COMMON)

NOT Conns syndrome

Question 2

Causes of Primary Hyperaldosteronism

Answer 2

• bilateral adrenal hyperplasia:
• adrenal adenoma (Conn’s)
• unilateral hyperplasia
• familial hyperaldosteronism
• adrenal carcinoma

Question 3

Describe the clinical features seen in Primary Hyperaldosteronism

Answer 3

• hypertension
• hypokalaemia
• metabolic alkalosis

Question 4

Who should be investigated for Primary Hyperaldosteronism?

Answer 4

• Hypertensive with hypokalaemia
• treatment resistant hypertension

Question 5

What is the first line investigation in suspected Primary Hyperaldosteronism?

Answer 5

• plasma aldosterone/renin ratio
• high aldosterone levels
• low renin levels (negative feedback due to sodium retention from aldosterone)

Question 6

What imaging should be undertaken if a patient has a positive plasma aldosterone/renin ratio?

Answer 6

High-resolution CT abdomen

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

Question 7

What treatment options are available for patients with confirmed Primary Hyperaldosteronism?

Answer 7

adenoma: laparoscopic surgery

bilateral hyperplasia: aldosterone antagonist e.g. spironolactone