Primary aldosteronism

Question 1

what does primary aldosteronism refer to

Answer 1

autonomous production of aldosterone independent of its regulators (angiotensin II and K+)

Question 2

what presenting features raise high suspicion of primary aldosteronism

Answer 2

hypertension and hypokalaemia in a young person

Question 3

what is the main action of mineralocorticoids when binding mineralocorticoid receptor(MR) at epithelial cells, such as aldosterone

Answer 3

increase Na+ reabsorption, and by doing so reduce K+

Question 4

what cardiovascular problems can arise from primary aldosteronism

Answer 4

increased sympathetic flow, increased BP, altered endothelial function, sodium retention, atheroma, LVH

Question 5

what is the commonest secondary cause of secondary hypertension

Answer 5

primary aldosteronism

Question 6

what are the clinical features of primary aldosteronism

Answer 6

hypertension, hypokalaemia(not everyone), alkalosis, some have mild hypernatraemia

Question 7

what are the subtypes of primary aldosteronism

Answer 7

bilateral adrenal hyperplasia(60%), adrenal adenoma(30%), genetic mutations or unilateral adenoma(both rare)

Question 8

what is another name for an adrenal adenoma causing primary aldosteronism

Answer 8

Conn’ syndrome

Question 9

describe the confirmation of excess aldosterone in the diagnosis of primary aldosteronism(PA)

Answer 9

measure plasma aldosterone and renin ratio, if raised investigate further with saline suppression test, failure to suppress aldosterone by >50% with 2l saline = PA

Question 10

what investigations can be done to determine the subtype of primary aldosteronism

Answer 10

adrenal CT/PET to check adenomas, sometimes adrenal vein sampling to confirm adenoma

Question 11

when is surgical treatment used for PA

Answer 11

if adrenal adenoma is cause, cures hypokalaemia and cures hypertension(in 30-70%)

Question 12

what surgical treatment would be used for PA

Answer 12

unilateral laparoscopic adrenalectomy

Question 13

when would pharmacological treatment be used for PA

Answer 13

for bilateral adrenal hyperplasia being the cause, or if other cause not suitable for surgery

Question 14

what pharmacological therapy can be used to treat PA

Answer 14

MR antagonists(eg spironolactone or eplerenone)

Question 15

how can adrenal vein sampling help surgery for PA

Answer 15

can confirm what side(left or right) adenoma is on if any doubt