Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Hypertension due to sodium and water retention Hypokalemia and metabolic alkalosis Suppressed renin and angiotensin synthesis Elevated plasma aldosterone levels Imaging results showing adrenal adenoma or bilateral hyperplasia +++ GENERAL CONSIDERATIONS ++ Increased autonomous production of aldosterone by the adrenal gland This causes sodium retention, plasma volume expansion, and hypertension Renal loss of potassium and bicarbonate causes hypokalemia and alkalosis – Patients usually identified because of hypertension and sometimes hypokalemia – Familial hyperaldosteronism is the cause in 5–10% of cases – Somatic mutations account for about 50% of cases and involve the genes encoding potassium channels, voltage-dependent C-type calcium channels, and sodium/potassium and calcium ATPases +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Usually asymptomatic +++ PHYSICAL EXAM FINDINGS ++ Hypertension, rarely severe +++ DIFFERENTIAL DIAGNOSIS ++ Other causes of hypertension (primary aldosteronism accounts for 10–20% of hypertensive patients referred to hypertension clinics) Other causes of hypokalemia +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Serum potassium reduced in about 40% – Reduced plasma renin activity – Elevated plasma aldosterone – Aldosterone to plasma renin ratio (the definition of abnormal varies with the laboratory) +++ ELECTROCARDIOGRAPHY ++ Occasionally left ventricular hypertrophy or left atrial abnormality is seen +++ IMAGING STUDIES ++ CT scan distinguishes adrenal hyperplasia from adenoma +++ DIAGNOSTIC PROCEDURES ++ Aldosterone suppression test Adrenal vein aldosterone levels in selected cases +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Suspected cardiac disease +++ HOSPITALIZATION CRITERIA ++ Planned surgery +++ MEDICATIONS ++ Aldosterone antagonists for adrenal hyperplasia: spironolactone 100–200 mg/day PO or eplerenone 25–100 mg/day Calcium channel blockers Amiloride 10–40 mg/day +++ THERAPEUTIC PROCEDURES ++ CT-guided radiofrequency ablation is a potential alternative to surgery for adenomas +++ SURGERY ++ Surgical resection of adenoma +++ DIET AND ACTIVITY ++ Low-sodium diet +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Successful surgery +++ FOLLOW-UP ++ Depends on situation +++ COMPLICATIONS ++ Those of systemic hypertension +++ PROGNOSIS ++ Excellent with early recognition and management +++ PREVENTION ++ Serum potassium off diuretics should be part of every hypertension evaluation In difficult to manage patients, a plasma aldosterone/renin activity ratio should be measured +++ RESOURCES ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth