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 15/06/21.