Endocrine System >
“Syndrome of excess production of aldosterone independent of the renin-angiotensin system (primary hyperaldosteronism)”
- Family history of primary hyperaldosteronism
- Family history of hypertension or stroke at <40 years old.
- Solitary aldosterone-producing adrenal adenoma.
- Primary hyperaldosteronism can also be due to bilateral adrenal hyperplasia and, rarely, familial hyperaldosteronism.
- Increased aldosterone levels.
- Increase in the number of sodium channels in the distal convoluted tubule of renal nephrons.
- Increased sodium and water reabsorption and increased potassium excretion.
- Negative feedback decreases renin production.
- Often asymptomatic.
- Muscle weakness
- May develop hypokalaemia induced diabetes insipidus (polyuria and polydipsia).
- Hypertension (secondary):
- Refractory to at least 3 medications
- Occurring <40 years old or associated with hypokalaemia
- Blood pressure (↑)
- U&Es (potassium↓)
- Serum aldosterone – renin ratio (↑)
- Adrenal vein sampling (compare sides; unilateral or bilateral)
- CT abdomen
- Serum aldosterone (↑)
- 24hr urinary aldosterone excretion (↑)
- ECG (changes due to hypokalaemia)
- ABG (metabolic alkalosis due to hypokalaemia)
- Laparoscopic adrenalectomy
- Aldosterone antagonists (e.g. spironolactone) given for 4 weeks pre-op
- Myocardial infarction
- Heart failure
- Kidney failure