Primary hyperaldosteronism

INTRODUCTION:
  • Most common cause of refractory hypertension in youths and middle-aged adults
  • Excess aldosterone
    Increased ENaC activity
    Hypokalemia– muscle weakness
    Hypernatremia
    Hydrogen depletion - metabolic alkalosis
    ↑ECF and plasma volume
    Hypokalemic Hypertension – clinical hallmark
    Direct damage to myocardium and glomeruli
    Mild hypomagnesemia
    Low renin
    Polyuria and polydypsia
    Edema is absent
Investigations:
  • Aldosterone: renin ratio (ARR) is the screening test for primary hyperaldosteronism in hypertensives
  • If ARR> 30- CT adrenals
  • Single adenoma, age
  • No mass
  1. Surgery not desired – medical treatment
  2. Surgery desired - Adrenal venous sampling
  • Bilateral hyperplasia – medical treatment
  • Unilateral hyperplasia - surgery
  • Class,Triad of Biochemical Criteria for diagnosis of Primary Hyperaldoteronism
  • Hypokalemia with inappropriate kaliuresis (Metabolic alkalosis)
  • Suppressed plasma renin activity
  • Elevated Aldosterone levels that do not fall appropriately in response to volume expansion or sodium load
Treatment:
  • Conn's syndrome - laparoscopic adrenalectomy
  • Bilateral adrenal hyperplasia - Spironolactone(Mineralocorticoid receptor antagonist) or Eplerenone or Amiloride (blocks ENaC)
Exam Question
  • Diastolic hypertension, Polyuria and Hypokalemia are seen in primary hyperaldosteronism
  • Class,Triad of Biochemical Criteria for diagnosis of Primary Hyperaldoteronism
  • Hypokalemia with inappropriate kaliuresis (Metabolic alkalosis)
  • Suppressed plasma renin activity
  • Elevated Aldosterone levels that do not fall appropriately in response to volume expansion or sodium load
  • Primary hyperaldosteronism lead to Hypernatremia,Hydrogen depletion and metablic alkalosis, Hypertension

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