Primary Hyperaldosteronism Flashcards

1
Q

What is primary hyperaldosteronism?

A

Autonomous aldosterone overproduction from the adrenal gland with subsequent suppression of plasma renin activity

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2
Q

Give the 2 main causes of primary hyperaldosteronism?

A

Idiopathic bilateral adrenal hyperplasia (60%)

Adrenal adenoma: Conn’s syndrome (40%)

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3
Q

What rare causes are there for primary hyperaldosteronism?

A

Familial hyperaldosteronism

Aldosterone producing adrenal carcinoma

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4
Q

Describe the pathophysiology of primary hyperaldosteronism

A

Excess aldosterone causes increased Na+ + water retention
Leads to increased blood volume + HTN
Also causes increased renal K+ loss leading to hypokalaemia
Renin is suppressed due to NaCl retention

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5
Q

Describe the epidemiology of primary hyperaldosteronism

A

5-10% of hypertensive patients
Conn’s syndrome F > M
Bilateral adrenal hyperplasia M>F

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6
Q

List 7 symptoms hypokalaemia

A
Fatigue 
Muscle weakness
Headaches
Constipation 
Palpitations  
Polyuria + polydipsia (due to nephrogenic DI) 
Paraesthesia (metabolic alkalosis)
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7
Q

List 4 signs of primary hyperaldosteronism

A
HTN (drug resistant) 
Complications of HTN e.g.
Headaches
Facial flushing
Hypertensive retinopathy
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8
Q

What screening tests can be used for primary hyperaldosteronism?

A
Low Serum K+  
Normal/ mild hypernatraemia as Na+ reabsorption is matched by water reabsorption  
High Urine K+ 
High Plasma Aldosterone Concentration 
High aldosterone: renin activity ratio
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9
Q

What confirmatory tests can be used for primary hyperaldosteronism?

A

Salt Loading
Failure of aldosterone suppression following salt load
CT/MRI: to detect tumour or hyperplasia

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10
Q

Why perform a bilateral adrenal vein catheterisation?

A

Measures adrenal vein aldosterone levels
Conn’s syndrome: discrepancy between adrenal levels
Bilateral adrenal hyperplasia: no difference between sides

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11
Q

How does Radio-labelled cholesterol scanning differentiate between causes of primary hyperaldosteronism?

A

Unilateral uptake in adrenal adenomas

Bilateral uptake in bilateral adrenal hyperplasia

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12
Q

Describe the management of bilateral adrenal hyperplasia

A

Spironolactone or Eplerenone
Amiloride (K+ sparing diuretic)
Monitor serum K+, creatinine + BP
ACEi + CCBs may also be added

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13
Q

Describe the management of Conn’s syndrome

A

Adrenalectomy

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14
Q

Describe the management of an adrenal carcinoma

A

Surgery

Post-operative mitotane (antineoplastic)

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15
Q

What complications may arise due to primary hyperaldosteronism?

A

Complications of HTN

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16
Q

What is the prognosis in primary hyperaldosteronism?

A

Surgery may cure HTN

Or may make HTN easier to treat with anti-hypertensive medication

17
Q

What are the main consequences of high aldosterone?

A

Increased Na + water retention, increases blood volume + BP = HTN + HYPERNATRAEMIA
Increased K+ excretion = HYPOKALAEMIA
Increased H+ excretion = ALKALOSIS

18
Q

How does primary hyperaldosteronism usually present?

A

Often asymptomatic

Often incidental finding