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Snapshot
  • A 27-year-old male presents with headaches, muscle weakness, and high blood pressure. A basic metabolic panel showedNa+ of 147 and K+ of 3.1. CT of the abdomen is given at right.
Introduction
  • A disease caused by overproduction of aldosterone
  • May be of primary or secondary causes
    • primary hyperaldosteronism 
      • direct secretion of unregulated aldosteronism
      • majority are caused by unilateral adrenal (zona glomerulosal) adenoma 
        • also known as Conn's syndrome
      • also bilateral adrenal hyperplasia of zona glomerulosa
    • secondary hyperaldosteronism
      • increased secretion of aldosterone as a result of increased stimulation by renin
      • seen in renal artery stenosis and CHF
        • the kidneys see an effective "low circulating volume state" and respond by activating the renin-angiotensin-aldosterone axis.
Presentation
  • Symptoms
    • headache
    • muscle weakness
      • secondary to hypokalemia
  • Physical exam
    • hypertension
      • hypernatremic hypertension
Evaluation
  • Labs
    • hypokalemia
    • +/- hypernatremia
      • hypernatremia is rarely found due to compensatory diuresis and resulting sodium loss secondary to increased circulating volume.
    • plasma renin
      • primary hyperaldosteronism
        • low renin 
          • negative feedback inhition by high aldsterone
      • secondary hyperaldosteronism
        • high renin
    • elevated 24-hour urine aldosterone
    • metabolic alkalosis
      • due to dumping of H+ for Na+
Treatment
  • Spirolactone
    • indications
      • indicated to normalize blood pressure and hypokalemia
    • mechanism
      • spirolactone is an aldosterone receptor antagonist
 

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