hyperaldosteronism
HYPERALDOSTERONISM
Hyperaldosteronism is a group of disorders in which aldosterone production is inappropriately high, relatively autonomous & non-suppressible by sodium loading.
Signs & symptoms are nonspecific.
Symptoms are caused by hypertension (eg headache), hypokalemia (eg polyuria, nocturia, muscle cramps & weakness, tetany, paralysis, etc) & metabolic alkalosis.

Definition

  • Hyperaldosteronism is a group of disorders in which aldosterone production is inappropriately high, relatively autonomous and non-suppressible by sodium loading

Etiology

  • Hyperplasia eg idiopathic (bilateral) hyperplasia, primary (unilateral) adrenal hyperplasia
  • Familial Hyperaldosteronism II
    • Non-glucocorticoid remediable; maybe associated with familial occurrence of aldosterone-producing adenoma, idiopathic hyperaldosteronism, or both
Glucocorticoid-Remediable Aldosteronism (Familial Hyperaldosteronism I)
  • Monogenetic disorder related to hypertension
  • Adrenocortical hyperplasia is present which may be nodular
    • Histological features suggest over activity of the zona fasciculata
    • Progression to tumor has not been reported
  • Patients are usually asymptomatic young hypertensives
  • Diagnosis may be made with suppression of plasma aldosterone with Dexamethasone or southern blotting of genetic defect
  • Treat with low-dose Dexamethasone
Apparent Mineralocorticoid Excess
  • Rare congenital condition
  • Spironolactone may be used to control electrolyte imbalance
  • Blood pressure (BP) control usually needs other antihypertensive agents
    • Eg Angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics
  • Low-dose Dexamethasone may be useful

Liddle’s Syndrome

  • Rare congenital condition
  • Treat with Spironolactone but may also require Amiloride or Triamterene

Signs and Symptoms

  • Signs and symptoms are nonspecific
    • Symptoms caused by hypertension (eg headache), hypokalemia (eg polyuria, nocturia, muscle cramps and weakness, tetany, paralysis, etc), and metabolic alkalosis
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