Primary hyperaldosteronism



Background

  • XS aldosteronism - Na+ retention, hypertension and hypokalaemia.
  • Rare (< 1%) causes of hypertension.
  • Adrenal adenoma = Conn’s synd = 60% primary hyperaldosteronism ( hyperplasia etc.)
  • Adenomas in young women, bilateral hyperplasia in older men.

Presenting

  • Hypertension plus hypokalaemia
  • Weakness, nocturia and tetany

Diagnosis

  • Increased (>30mmol/day) urinary potassium loss with hypokalaemia
  • High aldosterone levels not suppressed by saline or fludrocortisone
  • Suppressed renin activity ( beware β-blockers may do similar)
  • Then CT or venous catheterisation

Secondary Hyperaldosteronism

  • XS renin and so angiotensin 2 causing stimulation of zona glomerulosa
  • Causes - accelerated hi BP, renal art stenosis.
  • Causes in normal BP = CCF and cirrhosis etc.
  • Spironolactone useful in both.
  • ACEI (e.g. Captopril ) good for failure.

Treatment

  • Surgery in Conn's
  • Spironolactone (aldosterone antagonist) in hyperplasias (or amiloride -less gynacomastia)

Content by Dr Íomhar O' Sullivan 14/03/2009. Reviewed Dr ÍOS 12/12/2011. Last review Dr ÍOS 5/12/18.