Primary Hyperaldosteronism

Question 1

What is primary hyperaldosteronsim.

Answer 1

Excess production of aldosterone, independent of the renin-angiotensin system.

Question 2

What does primary hyperaldosteronism cause. (2)

Answer 2

Raised sodium and water retention.

Low renin release.

Question 3

What features would make you consider primary hyperaldosteronism. (3)

Answer 3

Hypertension, hypokalaemia or alkalosis in someone not on diuretics.

Question 4

What are the symptoms of primary hyperaldosteronism. (7)

Answer 4

Often asymptomatic.

Signs of hypokalaemia:
Weakness. 
Cramps. 
Paraesthesia. 
Polyuria. 
Polydipsia. 
Raised BP (but not always).

Question 5

What are the causes of primary hyperaldosteronism. (4)

Answer 5

66% are due to a solitary aldosterone producing adenoma (Conn’s syndrome).
33% are due to bilateral adrenocortical hyperplasia.
Adrenal carcinoma.
Glucocorticoid-remediable aldosteronism.

Question 6

When should you consider Conn’s as the diagnosis in a patient with hyperaldosteronism. (3)

Answer 6

Hypertenson associated with hypokalaemia.
Refractory hypertension (eg despite >3 antihypertensive drugs).
Hypertension occurring before 40 (especially in women).