Primary Hyperaldosteronism

Question 1

CF

Answer 1

• hypertension
• hypokalaemia → muscle weakness
• metabolic alkalosis

Question 2

Causes

Answer 2

• Bilateral idiopathic adrenal hyperplasia - most common
• Adrenal adenoma (Conn’s syndrome) - 2nd most common
• Unilateral hyperplasia
• Familial hyperaldosteronism
• Adrenal carcinoma

Question 3

First line investigation?

Answer 3

Plasma aldosterone/renin ratio → high in this disease

Question 4

What is done after the 1st line investigation

Answer 4

High res CT abdo to differentiate between unilateral adenoma and bilateral hyperplasia

Question 5

What if CT is normal?

Answer 5

Adrenal venous sampling (AVS) to distinguish between unilateral and bilateral adenoma hyperplasia

Question 6

What if renin is higher in the aldosterone/ renin ratio

Answer 6

Think renal artery stenosis

Question 7

What if it’s an adrenal adenoma- what management

Answer 7

laparoscopic adrenalectomy

Question 8

What if it’s bilateral adrenocortical hyperplasia?

Answer 8

aldosterone antagonist e.g. spironolactone