Primary Hyperaldosteronism Flashcards
Define:
Characterised by autonomous aldosterone overproduction with suppression of renin
What is secondary hyperaldosteronism:
This is when the renin causes the high aldosterone as with renal artery stenosis, renal hypoperfusion, hypertension and diuretics.
Aetiology/risk factors:
High aldosterone leads to sodium retention leading to water retention and so hypertension. There will also be hypokalaemia.
Conn’s syndrome - adrenal adenoma = 70% of cases
Bilateral adrenocortical hyperplasia
Rare - glucocorticoid suppressible hyperaldosteronism.
Epidemiology:
1-2% of hypertensive patients
Conn’s - more common in females and the young
Bilateral adrenocortical hyperplasia - more common in males and presents at older age
Symptoms:
Usually asymp and it is an incidental finding
Hypokalaemia will cause:
- Muscle cramps
- Weakness
- polyuria and polydipsia
- parasthesia
- Tetany
Signs:
Hypertension
Complications of hypertension such as hypertensive retinopathy
Investigations:
Low serum potassium High urine potassium High plasma aldosterone concentration High aldosterone:renin ratio Genetic testing for GRA
Salt loading - there should be suppression of aldosterone
Postural test - in Conn’s the aldosterone will fall from 8am to 12am
CT/MRI - localise tumour
Radio-labelled cholesterol staining - unilateral in Conn’s and bilateral in BAH
Bilateral adrenal vein catherterisation
Management for bilateral adrenocortical hyperplasia:
Sprionolactone (diuretic but may cause gynaecomastia in which case Eplerenone can be used)
Amiloride (potassium sparing diuretic)
Monitor K+, BP and creatinine
May add CCB or ACEi
Management for Conn’s:
Surgical - laproscopic adrenalectomy
Management for GRA:
Dexamethasone
Management for adrenal carcinoma:
surgery
Mitotene post-op
Complications:
Hypertension complications
Prognosis:
Surgery may cure hypertension but may need hypertension medication to treat before the surgery
