Primary Hyperaldosteronism Flashcards

1
Q

Define Primary Hyperaldosteronism

A

Aldosterone production exceeds the body’ requirements and becomes relatively autonomous with regard to the RAAS + subsequent suppression of plasma renin activity

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2
Q

Aetiology of Primary Hyperaldosteronism

A

Excess aldosterone may be secondary to an adrenal adenoma (Conn’s syndrome, 70%)
Hyperplasia of the adrenal cortex (30%)

Rare: glucocorticoid-suppressible hyperaldosteronism or aldosterone producing adrenal carcinoma

Excess aldosterone -> sodium and water retention -> hypertension + increased potassium loss -> hypokalaemia + renin suppression

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3
Q

Risk factors for Primary Hyperaldosteronism

A

20-70
FHx of Primary Hyperaldosteronism
FHx of early onset hypertension and/or stroke

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4
Q

Symptoms of Primary Hyperaldosteronism

A

Usually asymptomatic, picked up on blood stests

Nocturia, polyuria (DI secondary to hypokalaemia)
Lethargy
Mood disturbance: irritability, anxiety, depression
Difficulty concentrating
Paraesthesia, muscles cramps
Muscle weakness
Palpitations

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5
Q

Signs of Primary Hyperaldosteronism

A

Hypertension

Complications of hypertension e.g. retinopathy

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6
Q

Investigations of Primary Hyperaldosteronism

A

Plasma potassium: LOW (or normal)
Aldosterone/renin ratio: raised, >70 (direct active) (aldosterone high, renin low) - stop hypertensives
Fludrocortisone suppression test: failure to suppress aldosterone

Urine potassium: high

Salt loading: failure of aldosterone suppression after sodium load
Postural test: aldosterone and renin levels increase in bilateral adrenal hyperplasia

CT/MRI: visualise any masses
Radio-labelled cholesterol scanning: adrenal adenoma (unilateral uptake), bilateral adrenal hyperplasia (bilateral uptake)

Bilateral adrenal vein catheterisation: distinguish between Conn’s and bilateral adrenal hyperplasia

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7
Q

Management for unilateral Aldosterone-secreting tumour

A

Unilateral laparoscopic adrenalectomy

Immediately before surgery withdraw potassium supplementation + aldosterone antagonsist + antihypertensives

Give post ops IV fluids without potassium

Non-surgical: aldosterone antagonistis e.g. amiloride, spironolactone, eplerenone

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8
Q

Management for bilateral aldosterone-secreting tumours

A

Non-surgical: aldosterone antagonistis e.g. amiloride, spironolactone, eplerenone

Laparascopic adrenalecomy

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9
Q

Management for Familial hyperaldosteronism type 1

A
  1. Glucocorticoids e.g. dexamethasone

2. Aldosterone antagonists e.g. amiloride

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10
Q

Complications Primary Hyperaldosteronism

A

Hypertension: stroke, MI, HF, AF, Impaired renal function
Perioperative: bleeding, infection, wound hernia, cardiovascular events
Hyperkalaemia (antagonist action)

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