aldosterone

Question 1

primary hyperaldosteronism (Conn’s syndrome)

Answer 1

excessive unregulated recreation of aldosterone by adrenal cortex.
tumor of adrenal cortex, adrenal adenoma
characteristic golden yellow colour

bilateral adrenal hyperplasia - bilateral adenomas, hyperplasia of zone glomerulosa

Question 2

secondary hyperaldosteronism

Answer 2

excessive secretion of renin by the juxtaglomerular apparatus of kidney. this is in response to
- renal ischemia (renal a stenosis/malignant hypertension)
- decreased intravascular volume (SHF, cirrhosis, nephrotic syndrome, laxative or diuretic abuse)
- Na wasting disorder (CKD, RTA)
- hyperplasia of the juxtaglomerular apparatus (Bartter’s syndrome)
- rening secreting tumors

Question 3

inherited form of hyperaldosteronism

Answer 3

GRA - Glucocorticoid remediable aldosteronism or familial hyperaldosteronism type 1 (CYP11B1/CYP11B2)
early onset HTN (milder BP elevation) hypokalaemia - mild affected have increased risk of premature stroke

Question 4

clinical consequences of MC excess

Answer 4

Na retention
K and H ion wasting by kidney

Question 5

hypoaldosteronism (primary MC deficiency)

Answer 5

destruction of MC synthesis
Hyponatermia, hypovolemia, hypotension, impaired secretion of potassium and hydrogen in the renal tubules > resulting in Hyperkalemia and metabolic acidosis. renin activity is increased

Question 6

secondary MC deficiency

Answer 6

exogenous sources such as Fludrocortisone / licorice

Question 7

hyporeninemic hypoaldosteronism (type IV RTA)

Answer 7

hyperkalemia, acidosis with mild chronic renal insufficiency
typically M in 50s - 70s, have underlying pyelonephritis, DM or gout.

plasma and urinary aldosterone levels are low, and renin levels low and unresponsive to ACTH stimulation, upright posture, dietary Na restriction, or furosemide administration.
impaired juxtaglomerular apparatus associated with the underlying renal disease.

2 genetic d/o: Congenital adrenal hyperplasia, pesudohypoaldosteronism