Hyperaldosteronism – Quick revision chart

Primary aldosteronism – Overproduction of the hormone aldosterone that leads to suppression of renin and influx of potassium , resulting in hypertension and hypokalemia ( and hypomagnesemia )

Excess production of the adrenal glands – can present as a primary tumor of the gland called as Conn’s syndrome or b/l adrenal hyperplasia

Mineralocorticoid excess- Excess production of the adrenal glands – can present as a primary tumor of the gland called as Conn’s syndrome or b/l adrenal hyperplasia

hypertension + inappropriately high aldosterone production , relatively autonomous from the renin-angiotensin system and non suppressible by Na loading affects 5 % to 15 % of hypertensives most common cause of 2ary hypertension initially described by Conn as hypertension / severe hypokalemia & mild hyponatremia Studies have now shown that only a minority of patients with PA present with hypokalemia and normokalemic hypertension is a more common presentation

unilateral aldosterone producing adenoma ( APA )Conns syndrome, b/l idiopathic hyperplasia primary U/L hyperplasia familial causes

Screening – high risk populations , patients with resistant hypertension , hypertension & spontaneous or diuretic induced hypokalaemia , hypertension and an adrenal mass , or hypertension & a family h.o early onset HT or CV accident at a young onset, hypertension & sleep apnoea

Testing – Serum ( or ) plasma aldosterone & plasma renin Aldosterone -to-renin ratio ( ARR )

Clinical suspicion of PA / tests ( e.g low renin and raised aldosterone ) refer endocrinology or to hypertension specialists

Secondary aldosteronism – Hypertensive as renal artery stenosis , aortic coarctation 
 Normotensive as in Gittleman’s syndrome , Barttler’s synd

REFERENCES

1. Papadopoulou-Marketou N, Vaidya A, Dluhy R, et al. Hyperaldosteronism. [Updated 2020 Aug 6]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279065/
2. IN DEPTH Primary Aldosteronism Practical Approach to Diagnosis and Management James Brian Byrd, MD, MS
   Adina F. Turcu, MD Richard J. Auchus, MD, PhD Circulation. 2018;138:823–835. DOI: 10.1161/CIRCULATIONAHA.118.033597
3. Vakkalanka S, Zhao A, Samannodi M
   Primary hyperaldosteronism: a case of unilateral adrenal hyperplasia with contralateral incidentaloma
   Case Reports 2016;2016:bcr2016216209. Primary hyperaldosteronism: a case of unilateral adrenal hyperplasia with contralateral incidentaloma | BMJ Case Reports
4. Fagugli, Riccardo Maria, and Chiara Taglioni. “Changes in the perceived epidemiology of primary hyperaldosteronism.” International journal of hypertension vol. 2011 (2011): 162804. doi:10.4061/2011/162804