Primary hyperaldosteronism
Presenting
- Hypertension plus hypokalaemia
- Weakness, nocturia and tetany
- XS aldosteronism - Na+ retention, hypertension and hypokalaemia.
- Rare (< 1%) causes of hypertension.
- Adrenal adenoma = Conn’s synd = 60% primary hyperaldosteronism ( hyperplasia etc.)
- Adenomas in young women, bilateral hyperplasia in older men.
Secondary Hyperaldosteronism
- XS renin and so angiotensin 2 causing stimulation of zona glomerulosa
- Causes - accelerated hi BP, reanl art stenosis.
- Causes in normal BP = CCF and cirrhosis etc.
- Spironolactone useful in both.
- ACEI (eg captopril ) good for failure.
Diagnosis
- Increased (>30mmol/day) urinary potassium loss with hypokalaemia
- High aldosterone levels not suppressed by saline or fludrocortisone
- Suppressed renin activity ( beware Β-blockers may do similar)
- Then CT or venous catheterisation
Treatment
- Surgery in Conn's
- Spironolactone (aldosterone antagonist) in hyperplasias (or amiloride -less gynacomastia)
