(!) Primary hyperaldosteronism

Question 1

Define Primary hyperaldosteronism

Answer 1

Primary hyperaldosteronism or Conn’s syndrome, is characterised by high levels of aldosterone produced by the adrenal glands, without regulation by the RAAS system
quite a common cause of hypertensions

Some types are congenital/related to 1 gene mutations (FH1-4)

Question 2

Aetiology and risk factor of Primary hyperaldosteronism

Answer 2

Aetiology of most forms of Conns is unknown
at least some form of genetics-
Most cases are sporadic-not single gene
few cases of single gene causes-rare (FH1-4)
usually related to bilateral adrenal hyperplasia or adrenal adenomas, or unilateral hyperplasia
causes excessive sodium and water retention, and excessive potassium and hydrogen loss

risk factors
family Hx of Conn’s
FHx history of hypertension/stroke
age 20-70

Question 3

Epidiemology of Primary hyperaldosteronism

Answer 3

PA is often seen as rare cause of hypertension-and only considered if concurrent hypokalemia

but found that a lot of conns have normokalamiea
6% prevalence in spain
prevalence ranging from 6 to 35% of hypertensives

Question 4

Signs and Sx of Primary hyperaldosteronism

Answer 4

The main one, often only one-
hypertension
-consider checkin in any HTN patient, regardless of hypokalaemia

can have nocturia, polydypsia, lethargy, difficulty concentration

and/or-muscle cramps, parasthesia, palpitations, muscle weakness-hypokalaemia

Question 5

Investigations of Primary hyperaldosteronism

Answer 5

Plasma potassium-
can be low, but very often nromal

Aldosterone/renin ratio-elevated
but not that reliable

Fludrocortisone suppression testing-give fludro then measure aldosterone-if not supressed-conns
Most reliable test

Saline infusion-not suppress Aldo

adrenal CT-see unilateral or bilateral mass

Question 6

Management of Primary hyperaldosteronism

Answer 6

manage and treat hypokalaemia if present

30% have clear defined adrenal mass, unilateral that produces -unilateral adrenalectomy is mainly curative of hyper tense and hypokalaemia

medical management-if not clearly unilateral/unfit for surgery
Spirolactone is literally a aldosterone antagonist (mimics and competes with it)-not high doses

other potassium sparing diuretics are good-amiloride (acts on where aldosterone effects-sodium channels-blocks em)
But have slow onset of hypotensive effects-

Might need more HTN medications

Steroids can have a suppressive effects in sometypes-FH1

Question 7

Complications of Primary hyperaldosteronism

Answer 7

any surgery complication, esp abdomen (adhesions, hernia)

Vascular HTN issues-
Stroke, CVD, MI, heart failure

AFib related both to HTN and hypokalemia

HTN can cause renal injury

Question 8

Prognosis of Primary hyperaldosteronism

Answer 8

Surgery tends to cure 70% of those that are eligible for it-improves HTN and CVD risk
recurrence is uncommon

Medical treatment is good, and controls it, but slower and might need help from other HTN medication
hypokalaemia nevers stays

Steroids are great for FH1