Hyperaldosteronism

Question 1

Another name for Conn’s syndrome

Answer 1

Primary hyperaldosteronism

Question 2

Pathophysiology of primary hyperaldosteronism

• renin levels

Answer 2

adrenal glands produce too much aldosterone

• renin will be low

Question 3

Renin levels in primary hyperaldosteronism

Answer 3

low - due to renin secretion suppressed by high BP

Question 4

Causes of primary hyperaldosteronism

Answer 4

• An adrenal adenoma secreting aldosterone
• Bilateral adrenal hyperplasia
• Familial hyperaldosteronism type 1 and type 2 (rare)
• Adrenal carcinoma (rare)

Question 5

Pathophysiology in secondary hyperaldosteronism

Answer 5

excessive renin -> stimulation of adrenal glands -> excessive aldosterone

Question 6

renin levels in secondary hyperaldosteronism

Answer 6

high

Question 7

Causes of secondary hyperaldosteronism

Answer 7

There are several causes of high renin levels and they occur when the blood pressure in the kidneys is disproportionately lower than the blood pressure in the rest of the body:

• Renal artery stenosis
• Renal artery obstruction
• Heart failure

Question 8

What’s the blood screening tool used in suspected hyperaldosteronism?

Answer 8

renin : aldosterone ratio

• High aldosterone and low renin indicates primary hyperaldosteronism
• High aldosterone and high renin indicates secondary hyperaldosteronism

Question 9

Results of renin : aldosterone ratio in Primary hyperaldosteronism

Answer 9

• High aldosterone and low renin indicates primary hyperaldosteronism

Question 10

Results of:

renin : aldosterone ratio in secondary hyperaldosteronism

Answer 10

High aldosterone and high renin indicates secondary hyperaldosteronism

Question 11

Other (than renin : aldosterone ratio) investigations in hyperaldosteronism

Answer 11

Other investigations relating to the effects of aldosterone:

• Blood pressure (hypertension)
• Serum electrolytes (hypokalaemia)
• Blood gas analysis (alkalosis)
• CT / MRI to look for an adrenal tumour
• Renal doppler ultrasound, CT angiogram or MRA for renal artery stenosis or obstruction

Question 12

Medical treatment of hyperaldosteronism

Answer 12

Aldosterone antagonists

• Eplerenone
• Spironolactone

Question 13

Surgical treatment of hyperaldosteronism

Answer 13

• Surgical removal of adenoma
• Percutaneous renal artery angioplasty via the femoral artery to treat in renal artery stenosis