Primary hyperaldosteronism

Question 1

Definition

Answer 1

Increased production of aldosterone
This causes sodium and water retention
Leading to hypertension

Question 2

Hyperaldosteronism conditions (2)

Answer 2

Conn’s syndrome

Bilateral adrenal hyperplasia

Question 3

Clinical features

Answer 3

Significant hypertension 
Hypokalaemia 
Fatigue
Headache
Muscle weakness

Question 4

Investigations

Answer 4

Measure plasma aldosterone level
Measure renin levels
If Aldosterone:renin is raised, further investigations required 
Saline suppression test 
CT adrenals

Question 5

Saline suppression test

Answer 5

Failure of aldosterone level to suppress over 50% with 2L of saline confirms the diagnosis of hyperaldosteronism

Question 6

Conn’s syndrome - definition

Answer 6

Tumour present in the zona glomerulosa where the cells here secrete excess aldosterone
Thus, there is increased sodium and water retention
Increased potassium loss

Question 7

Conn’s syndrome - pathology

Answer 7

Tumours are small and yellow

Question 8

Conn’s syndrome - investigations

Answer 8

Aldosterone:renin - if ratio is raised, need further investigations…
Saline suppression test
CT adrenals - show an adenoma

Question 9

Conn’s syndrome - management

Answer 9

Surgery (adrenalectomy)

Question 10

Bilateral adrenal hyperplasia - definition

Answer 10

Diffuse or nodular hyperplasia of both adrenal glands

Question 11

Bilateral adrenal hyperplasia - management

Answer 11

Spironolactone

Doesn’t need surgery