Primary Hyperaldosteronism

Question 1

Define primary hyperaldosteronism.

Answer 1

In primary aldosteronism (PA), aldosterone production exceeds the body’s requirements and is relatively autonomous with regard to its normal chronic regulator, the renin-angiotensin II system.

Question 2

Explain the aetiology/risk factors of primary hyperaldosteronism.

Answer 2

Family history of PA
Family history of early onset of hypertension and/or stroke

Question 3

Summarise the epidemiology of primary hyperaldosteronism.

Answer 3

For many years, PA was considered a rare (<1%) cause of hypertension and not worth seeking unless hypokalaemia was present. However, since 1992, evidence has accumulated that PA is much more common than was previously thought, and that most patients are normokalaemic.

Question 4

Recognise the presenting symptoms of primary hyperaldosteronism. Recognise the signs of primary hyperaldosteronism on physical examination.

Answer 4

Hypertension
Age 20 to 70 years
Nocturia, polyuria
Lethargy
Mood disturbance (irritability, anxiety, depression)
Difficulty concentrating

Question 5

Identify appropriate investigations for primary hyperaldosteronism and interpret the results.

Answer 5

Plasma potassium
Aldosterone/renin ratio

Question 6

Generate a management plan for primary hyperaldosteronism.

Answer 6

Aldosterone antagonists
Unilateral adrenalectomy

Question 7

Identify the possible complications of primary hyperaldosteronism and its management.

Answer 7

Perioperative complications
Stroke
Myocardial infarction
Heart failure
Atrial fibrillation
Impaired renal function
Aldosterone antagonist- or mineralocorticoid receptor antagonist-induced hyperkalaemia

Question 8

Summarise the prognosis for patients with primary hyperaldosteronism.

Answer 8

Patients undergoing unilateral adrenalectomy for unilateral PA:
This procedure leads to cure of hypertension in 50% to 60% of carefully selected patients and improvement in all of the remainder.