Hyperaldosteronism

Question 1

What is hyperaldosteronism?

Answer 1

clinical manifestations of excess aldosterone production

Question 2

What are primary causes of hyperaldosteronism?

Answer 2

1. adrenal adenoma (Conn’s)
2. bilateral adrenal hyperplasia
3. adrenal carcinoma (rare)

Question 3

What are secondary causes of hyperaldosteronism?

Answer 3

anything driving excess activation of RAAS

Question 4

When is renin produced?

Answer 4

1. in response to stimulation from JG cells in the kidney

2. detects circulating blood volume and sodium levels

Question 5

What does renin act on?

Answer 5

angiotensinogen and it is converted to AT 1 then ACE from the lungs converts AT 1 to AT II

Question 6

What does AT II do?

Answer 6

is the signal that drives aldosterone production in the adrenals

Question 7

What does the high aldosterone do?

Answer 7

exhibits negative feedback on the RAAS so renin would be low

Question 8

What syndromes can cause secondary hyperaldosteronism?

Answer 8

1. renin secreting tumours
2. renal artery stenosis
3. genetic syndromes
4. physiological state of hypovolaemia

Question 9

What is the presentation of hyperaldosteronism?

Answer 9

1. Hypertension in young person

2. Hypokalamia

Question 10

What would the hyperaldosteronism symptoms be in young person (hypertension)?

Answer 10

1. headach
2. visual changes
3. SOB
4. CP
   • Often refractory to treatment

Question 11

What are symptoms of hypokalamia?

Answer 11

1. cardiac arrhythmias
2. polyuria
3. polydipsia
4. muscle weakness

Question 12

What are Conn’s syndrome features?

Answer 12

1. High aldosterone
2. High BP
3. Low blood K+
4. Polyuria
5. Fatigue

Question 13

What investigations are done for hyperaldosteronism?

Answer 13

1. Blood pressure
2. Bloods
   • Sodium
   • Potassium
3. Aldosterone : renin ratio (screening for primary causes)
4. Further adrenal imaging

Question 14

What is the management for an adrenal adenoma (Conn’s)?

Answer 14

spironolactone (aldosterone antagonist)

Question 15

What is the management for bilateral adrenal hyperplasia?

Answer 15

aldosterone antagonists – spironolactone

Question 16

How do you manage the secondary causes of hyperaldosteronism?

Answer 16

treat underlying aetiology