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Flashcards in Hyperaldosteronism- Carroll Deck (10):


When is renin released?


What does renin do?


What acts as negative feedback for renin?


Renin is released when there is a decrease in blood pressure (IE hemorrhage, dehydration, sodium deplation)


Renin converts angiotensinogen into angiotensin I


Angiotensin II negatively feedbacks to renin



What two roles does angiotensin II have?


What activates angiotensin II?






  1. Vasoconstricts vascular smooth muscle
  2. Stimulates the adrenal gland to release aldosterone


Angiotensin Converting Enzyme (ACE)



What does aldosterone do?


Where does it act?


Aldosterone upregulates apical sodium channels and basolateral Na/K pumps to conserve sodium and excrete hydrogen and potassium


Collecting duct of the nephron



What are four classes of drugs that affect the RAAS pathway?


Give a drug for each class


  1. Direct Renin inhibitors
    • Aliskiren 
  2. ACE inhibitors
    • Lisinopril, Captopril, Enalapril
  3. Angiotensin Receptor Blockers
    • Losartan
  4. Mineralocorticoid Receptor Antagonist
    • Spironolactone 



What is the etiology behind primary hyperaldosteronism?


What symptoms/clinical signs are seen?


The adrenal gland overproduces aldosterone, due to some sort of overgrowth (cancer, hyperplasia, etc)


  • Hypertension younger than 30
  • Hypertension greater than 160/100
  • Hypertension with hypokalemia 
  • Resistant hypertension



What are the initial tests for primary hyperaldosteronism?


What are the confirmatory tests?


Initial Tests

  • Plasma Aldosterone Concentration >15ng/dL
  • Plasma Renin Activity <1.0 ng/mL/h
  • PAC:PRA  >20


Confirmatory Tests

  • Imaging of Adrenal glands
  • Bilateral renal vein sampling



What can cause primary hyperaldosteronism?


What can cause secondary hyperaldosteronism?


Primary hyperaldosteronism

  • adrenocortical adenoma
  • zona glomerulosa bilateral hyperplasia 


Secondary hyperaldosteronism

  • Renal Ischemia
  • Chronic Diuretic/Laxative Use
  • Hypoproteinemia
  • Renal failure
  • Heart failure



What should be done if a unilateral mass is found on the adrenals of a patient with hyperaldosteronism?


What should be done if both adrenals are found to be overproducing aldosteronism?





Medical management (IE spironolactone, eplerenone)



What are two genetic disorders that might produce similar symptoms as primary hyperaldosteronism?


What causes the pathology?


11-Beta hydroxysteroid dehydrogenase type 2

  • Lack of 11B-HSD2 causes a build-up of cortisol
  • Cortisol can activate the mineralocorticoid receptor


Liddle's Syndrome 

  • mutations in the ENaC channel cause it to be constitutively active
  • potassium waste  


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