Primary Hyperaldosteronism (Conn's)

Question 1

what is primary hyperaldosteronism?

Answer 1

a disorder caused by autonomous production of aldosterone by the adrenal cortex (e.g. due to hyperplasia, adenoma, or carcinoma)

Question 2

what is the aetiology of primary hyperaldosteronism?

Answer 2

• adrenal adenoma
• adrenal carcinoma
• adrenal hyperplasia
• familial hyperaldosteronism

Question 3

what are the symptoms of primary hyperaldosteronism?

Answer 3

• hypertension
• hypokalaemia (e.g. weakness, fatigue, polyuria, polydipsia, paraesthesia)
• hypernatraemia
• hypervolaemia

Question 4

what are the investigations for primary hyperaldosteronism?

Answer 4

• U&Es (e.g. hypokalaemia, hypernatraemia)
• plasma aldosterone ↑
• plasma renin activity (PRA) ↓
• CT/ MRI adrenal
• bilateral adrenal vein catheterisation
• saline infusion test / oral sodium loading test (e.g. ↑ aldosterone)

Question 5

which medications should be avoided before testing for primary hyperaldosteronism?

Answer 5

• thiazide diuretics
• ACEi
• ARBs
• BBs

Question 6

what is the management of primary hyperaldosteronism?

Answer 6

• laparoscopic adrenalectomy (e.g. adrenal adenoma/carcinoma)
• spironolactone/eplerenone (e.g. BAH)