Primary hyperaldosteronism Flashcards

1
Q

define primary hyperaldosteronism?

A

characterised by autonomous aldosterone overproduction from the adrenal gland with subsequent suppression of plasma renin activity

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2
Q

what are the causes of hyperaldosteronism?

A

• Adrenal cortex hyperplasia – MOST COMMON
• Adrenal adenoma (Conn’s syndrome)
• RARE:
o Aldosterone producing adrenal carcinoma

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3
Q

what is the pathophysiology of primary hyperaldosteronism?

A

o Excess aldosterone leads to increased Na+ and water retention
o This leads to hypertension
o It also causes increased renal K+ loss leading to hypokalaemia
o Renin is suppressed due to NaCl retention

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4
Q

what is the epidemiology of primary hyperaldosteronism?

A
  • 1-2% of hypertensive patients
  • Bilateral adrenal hyperplasia is more common in MEN and presents at an older age
  • Conn’s syndrome is more common in WOMEN and YOUNG patients
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5
Q

main features of hyperaldosteronism?

A

hypertension, hypokalaemia

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6
Q

symptoms of hypokalaemia?

A

o Muscle weakness
o Polyuria and polydipsia (due to nephrogenic DI)
o Paraesthesia
o Tetany

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7
Q

what are the signs of primary hyperaldosteronism?

A

• Hypertension

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8
Q

first line investigation for hyperaldosteronism?

A

Aldosterone/renin ratio

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9
Q

next line investigation for hyperaldosteronism?

A

High resolution CT abdomen and adrenal vein cathertisation
- Measures adrenal vein aldosterone levels and allows you to distinguish between Conn’s syndrome (unilateral ) and bilateral adrenal hyperplasia (bilateral)

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10
Q

what might the bloods show?

A

o Low Serum K+
o Serum Na+ is usually normal
o High Plasma Aldosterone Concentration

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11
Q

what is the postural test?

A
  • Measure plasma aldosterone, renin activity and cortisol when the patient is lying down at 8 am
  • Measure again after 4 hrs of the patient being upright
  • Aldosterone-producing adenoma - aldosterone secretion decreases between 8 am and noon
  • Bilateral adrenal hyperplasia - adrenals respond to standing posture and increase renin production leading to increased aldosterone secretion
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12
Q

how to manage bilateral adrenal hyperplasia?

A

spironolactone

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13
Q

how to manage conns syndrome?

A

o Adrenalectomy

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14
Q

how to manage an adrenal carcinoma?

A

o Surgery

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15
Q

what are the complications of primary hyperaldosteronism ?

A

• Complications of hypertension

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16
Q

prognosis?

A

good