Aldosteronism

Primary aldosteronism (Conn’s syndrome)

Introduction 

Primary aldosteronism occurs when the adrenal glands produce too much of the steroid hormone aldosterone, which helps control sodium and potassium excretion 

-Excessive aldosterone production increases sodium retention and suppresses plasma renin 

-It increases renal potassium excretion, which can lead to hypokalemia 

-The most common cause of refractory hypertension in young and middle-aged adults: Primary aldosteronism 

-Most frequent cause of primary aldosteronism: Bilateral adrenal cortical hyperplasia 

Symptoms & signs

Fatigue, edema, tingling, muscle weakness, excessive thirst, frequent urination, visual disturbances, normotension, hypertension, paresthesias with tetany, headache, polyuria and polydipsia 

Diagnosis

Labs: low plasma renin; low potassium;  Elevated plasma and urine aldosterone levels, sodium bicarbonate levels 

Imaging: Adrenal CT 

Treatment 

Unilateral Adrenal adenoma: usually treated by adrenalectomy 

Bilateral adrenal hyperplasia: usually treated with medical therapy 

Medications: Spironolactone, Eplerenone, Amiloride

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