hyperaldosteronism

Question 1

what is primary hyperaldosteronism

Answer 1

an excess of aldosterone caused by autonomous overproduction. It is typically due to adrenal hyperplasia (most commonly bilateral) or adrenal adenoma (typically unilateral).

common cause of secondary hypertension

Question 2

high systemic aldosterone leads to

Answer 2

High systemic aldosterone levels result in increased renal sodium reabsorption and potassium secretion, which lead to water retention and hypokalemia. Patients are often asymptomatic and found to have hypertension at routine health checks.

Question 3

is hypertension due to primary hyperaldosteronism generally responsive to medication

Answer 3

Hypertension due to primary hyperaldosteronism is often resistant to pharmacotherapy, and patients may have other signs suggestive of secondary hypertension, such as onset before the age of 30 or after the age of 55.

Question 4

general management of hyperaldosteronism

Answer 4

Treatment of unilateral disease consists of surgical resection, whereas bilateral disease is managed medically with aldosterone antagonists (e.g., spironolactone, eplerenone).

Question 5

common causes of primary hyperaldosteronism

Answer 5

Aldosterone-producing adrenal adenoma: ♀ > ♂ (2:1)
Adrenal hyperplasia ♂ > ♀ (4:1)

Question 6

aldosterone-to-renin ratio

Answer 6

The aldosterone-to-renin ratio (ARR) is used to screen for primary hyperaldosteronism and differentiate it from other causes of elevated aldosterone (e.g., secondary hyperaldosteronism).

↑ ARR: positive screening result

Question 7

confirmatory studies for primary hyperaldosteronism

Answer 7

to verify that the aldosterone production is non-suppressible
oral sodium loading test: high sodium intake for 3 days and collect 24 hour urine aldosterone on the last day
saline infusion test: infuse normal saline over 4 hours, primary hyperaldosteronism is probable if aldosterone levels remain high

Question 8

imaging/ investigations for primary hyperaldosteronism

Answer 8

adrenal CT: to exclude large tumours and differentiate possible surgical candidates eg. unilateral adenoma from non-surgical candidates eg. bilateral adrenal hyperplasia

adrenal venous sampling to determine ratio of disease between right and left adrenal veins