Hyperaldosteronism (primary) Flashcards Preview

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Flashcards in Hyperaldosteronism (primary) Deck (9)
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1
Q

def of hyperaldosteronism

A

autonomous aldosterone overproduction from adrenal gland with subsequent suppression of plasma renin activity

2
Q

aetiology of hyperaldosteronism

A

excess aldosterone may be secondary to:
1 adrenal adenoma (Conns syndrome) 70%
2 hyperplasia of the adrenal cortex 30%
3 glucocorticoid suppressible hyperaldosteronism 3%

excess aldosterone results in:

  • high Na reabsorption & water retention causing HTN
  • high K secretion & hypokalaemia
  • suppression of renin because of nacl retention
3
Q

epi of hyperaldosteronism

A

prevalence in hypertensive patients is very low
aldosterone producing adenomas are more common in women & <50yrs
bilateral adrenal hyperplasia occurs more commonly in men & presents at an older age

4
Q

history of hyperaldosteronism

A
often asymptomatic
symptoms of hypokalaemia
-muscle weakness
-polyuria &amp; polydipsia
-paraesthesia
5
Q

examination of hyperaldosteronism

A

HTN

6
Q

investigations performed in suspected hyperaldosteronism

A

screening tests
-decreased serum K (<4mmol/l) however normal serum Na due to parallel increase in the water content of the blood
-increased urine K
-increased plasma aldosterone concentration: plasma renin activity ratio
confirmatory tests
-salt loading (failure of aldosterone suppression following a salt load confirms primary hyperaldosteronism
-postural test (plasma aldosterone, renin activity & cortisol measured with patient lying flat in morning, after 4 hours standing up right the tests are repeated, ACTH sensitive adenomas cause aldosterone secretion to decrease from, bilateral adrenal hyperplasia, adrenals respond to standing posture by increasing renin & thus aldosterone secretion)
-CT/MRI to visualise adrenals
-bilateral adrenal vein catheterisation for distinction between conns & bilateral adrenal hyperplasia

7
Q

management of hyperaldosteronism

A

aldosterone producing adenomas
-adrenalectomy
bilateral adrenal hyperplasia
-spironolactone (aldosterone receptor anatagonist)
-change to eplerenone if spironolactone side effects are intolerable (gynaecomastia, impotence, menstrual irregularities)

8
Q

complications of hyperaldosteronism

A

HTN

9
Q

prognosis of hyperaldosteronism

A

surgery will cure 50% of HTN OR make it more responsive to anti-hypertensive therapy