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)