Primary hyperaldosteronism

Question 1

define primary hyperaldosteronism?

Answer 1

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

Question 2

what are the causes of hyperaldosteronism?

Answer 2

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

Question 3

what is the pathophysiology of primary hyperaldosteronism?

Answer 3

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

Question 4

what is the epidemiology of primary hyperaldosteronism?

Answer 4

• 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

Question 5

main features of hyperaldosteronism?

Answer 5

hypertension, hypokalaemia

Question 6

symptoms of hypokalaemia?

Answer 6

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

Question 7

what are the signs of primary hyperaldosteronism?

Answer 7

• Hypertension

Question 8

first line investigation for hyperaldosteronism?

Answer 8

Aldosterone/renin ratio

Question 9

next line investigation for hyperaldosteronism?

Answer 9

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)

Question 10

what might the bloods show?

Answer 10

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

Question 11

what is the postural test?

Answer 11

• 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

Question 12

how to manage bilateral adrenal hyperplasia?

Answer 12

spironolactone

Question 13

how to manage conns syndrome?

Answer 13

o Adrenalectomy

Question 14

how to manage an adrenal carcinoma?

Answer 14

o Surgery

Question 15

what are the complications of primary hyperaldosteronism ?

Answer 15

• Complications of hypertension

Question 16

prognosis?

Answer 16

good