Hyperaldosteronism

Question 1

What is Hyperaldosteronism?

Answer 1

Increased aldosterone secretion from Zona Glomerulosa of Adrenal Cortex

Question 2

What are the normal physiological steps that cause the release of Aldosterone? (5 steps)

Answer 2

1. Juxtaglomerular cells in Afferent arteriole in kidney sense LOW BP
2. Juxtaglomerular cells secrete Renin
3. Renin converts Angiotensiongen (from liver) –> Angiotensin I
4. ACE converts Angiotensin I –> Angiotensin II (in lungs)
5. Angiotensin II stimulates Adrenal glands to release Aldosterone

Question 3

What is the normal function of Aldosterone? (3 things)

Answer 3

= mineralcorticoid steroid hormone, acts on kidney INCREASE BP by:

1. Increase Na reabs @ DCT
2. Increase K secretion @ DCT
3. Increase H secretion @ CD

Question 4

What is Primary Hyperaldosteronism (aka Conn’s Syndrome)

Answer 4

Adrenal glands are responsible for too much aldosterone prod

Question 5

What are the causes of Primary Hyperaldosteronism? (4 things)

Answer 5

1. Adrenal adenoma (secreting aldosterone) (most common)
2. Adrenal hyperplasia
3. Inherited (rare)
4. Adrenal carcinoma (rare)

Question 6

What is Secondary Hyperaldosteronism?

Answer 6

When excessive RENIN is causing adrenal glands to prod more aldosterone

Question 7

What are the causes of Secondary Hyperaldosteronism? (2 things)

Answer 7

When BP in kidney much lower than rest of body in:

1. Renal artery stenosis / obst (athersclerosis)
2. HF

Question 8

What are the CF of Hyperaldosteronism? (5 things)

Answer 8

1. Treatment resistant HTN (headache + visual impairment)
2. Metabolic alkalosis
3. Signs of Hypokalaemia:

• Weakness
• Cramps
• Paraesthesiae (pins n needls)
• Polyuria + Polydipsia

1. Pitting oedema (Secondary HA)
2. Abd bruits (Secondary HA) (Renal artery stenosis)

(often asymptomatic tho)

Question 9

What investigations should you do for sus Hyperaldosteronism? (6 things)

Answer 9

1. Renin + aldosterone levels
2. Adrenal vein sampling
3. BP
4. UnE
5. ABG
6. CT / MRI
7. Renal doppler US / CT angiogram / MRA (MR angiogram)

Question 10

What do Renin + aldosterone levels tell you in sus Hyperaldosteronism?

Answer 10

• HIGH aldosterone + LOW renin = Primary Hyperaldosteronism
• HIGH aldosterone + HIGH renin = Secondary Hyperaldosteronism

Question 11

Why is Renin LOW in Primary but HIGH in Secondary Hyperaldosteronism?

Answer 11

• Primary = high aldosterone will do -ve fdbk = high BP will cause renin to be suppressed
• Secondary = Renin is high bc dis da whole cause of Secondary HA, bc BP in kidney much lower than rest of body

Question 12

Why is Adrenal Vein Sampling done in Primary Hyperaldosteronism? (3 things)

Answer 12

1. To measure Aldosterone levels in both adrenal veins
2. Unilateral n Bilateral differentials including: Aldosterone Producing Adenoma (APA) n Bilateral Adrenal Hyperplasia (BAH) etc
3. If unilateral disease = can be surgically resected

Question 13

Why is BP checked in sus Hyperaldosteronism?

Answer 13

To check the effect of high aldosterone

Question 14

Why should you do UnEs for sus Hyperaldosteronism?

Answer 14

To check for Hypokalaemia

Question 15

Why should you do an ABG for sus Hyperaldosteronism?

Answer 15

To check for Metabolic Alkalosis

Question 16

When should you do a CT / MRI for Hyperaldosteronism?

Answer 16

When you found HIGH Aldosterone levels n u wanna find the cause (e.g adrenal tumour)

Question 17

When should you do Renal doppler US / CT angiogram / MRA for Hyperaldosteronism?

Answer 17

When you sus Secondary HA n wanna check for Renal Artery Stenosis / Obst

Question 18

What are the management options for Hyperaldosteronism? (3 things)

Answer 18

1. Aldosterone antagonists (Spironolactone) (controls BP + K)
2. Surgical removal of Adenoma
3. Percutaneous Renal Artery Angioplasty via femoral artery to treat Renal Artery Stenosis

Angioplasty = opening up narrowed artery

Question 19

What is Hyperaldosteronism the most common cause of?

Answer 19

Secondary HTN

So if you ever have HTN das not responding to treatment, do a Renin:Aldosterone ratio screen for HA