Snapshot A 27-year-old male presents with headaches, muscle weakness, and high blood pressure. A basic metabolic panel showed a Na+ of 147 and K+ of 3.1. CT of the abdomen demonstrates bilateraly adrenal hyperplasia. 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 hyperplasiaof 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 inhibition by high aldosterone secondary hyperaldosteronism high renin elevated 24-hour urine aldosterone metabolic alkalosis due to dumping of H+ for Na+ Treatment Spironolactone indications indicated to normalize blood pressure and hypokalemia mechanism spironolactone is an aldosterone receptor antagonist