HYPERALDOSTERONISM

HYPERALDOSTERONISM

 It is a medical condition wherein too much aldosterone is produced by adrenal gland

 Hyperaldosteronism can be "primary" and "secondary"



Primary hyperaldosteronism

 Excess production of aldosterone due to

  • Bilateral adrenal hyperplasia (most common cause)
  • Adrenal adenoma(tumor in the first layer of cortex)→ CONN'S SYNDROME
 
Features: increase aldosterone cause more stimulation of epithelium sodium channel (E NaC) resulting in
  • Increase sodium and water absorption resulting in expansion of plasma volume
  • contralateral urinary loss of potassium and hydrogen


clinical features:

  • Headache due to hypertension
  • Urinary loss of potassium(hypokalemia) resulting in muscle cramps(weakness)
  • metabolic alkalosis due to loss of hydrogen ions
  • gain of water in the body → expansion of plasma volume which increase venous return → ANF release(atrial natriuretic factor)→ natriuresis(loss of water)
so, gain of water = loss of water(no pedal edema)
  • polyuria(due to ANF)
  • polydipsia




Investigations:


  • Sodium levels : increased
serum sodium values may be normal due to stimultaneous excess of water.but,total body salt is more
  • Potassium levels : decreased
  • ECG :
Normal T wave → < 5mm in limb leads, < 10mm in chest leads
In these patients → T wave smaller/absent/inverted T wave
ST depression can be seen
  • CT abdomen : shows bilateral adrenal hyperplasia or tumor
  • Plasma Renin : Plasma aldosterone ratio
best screening test
Autonomous tumor - increase aldosterone → negative inhibit of RAAS → Decrease renin level. thus, renin : aldosterone ratio decreased
results in low renin hypertension
  • IOC - SALINE INFUSION TEST/SALT LOADING TEST




TREATMENT:

  • CONN'S SYNDROME:                                      
Initially give spironolactone for 4-6weeks
(it is potassium sparing diuretic so manages both hypertension and hypokalemia)

Then get pre anaesthetic checkup (PAC) fitness to do surgery: unilateral laproscopic adrenalectomy


  • BILATERAL ADRENAL HYPERPLASIA:
DOC : Life long treatment with SPIRONOLACTONE
Side effect Gynecomastia in males
so, alternate drug EPLERENONE for males




SECONDARY HYPERALDOSTERONISM
Secondary hyperaldosteronism is due to overactivity of the renin angiotensin aldosterone system (RAAS)





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