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Back to Endocrine Diseases
Primary hyperaldosteronism
Causes
- Adrenal adenoma (Conn's syndrome)
- Bilateral adrenal hyperplasia
- Adrenal carcinoma
Clinical suspicion
Indistiguishable from hypertension except that it occurs at an early
age and usually is very high (malignant hypertension). It maybe accompanied
by potassium depletion.
Diagnosis
Elevated plasma aldosterone level that is not suppressed with saline
infusion or fludrocortisone adminstration.
Suppressed plasma renin activity. Plasma aldosterone/renin ratio exceeds
30.
Treatment
For adenoma the treatment is surgical removal. This leads to normalization
of blood pressure in 70% of the cases. If the blood pressure is not controlled
on spironolactone, it is unlikely to respond to surgery and such patients
should be controlled by convetntional antihypertensives.
For hyperplasia, spironolactone 100-400mg daily or amiloride 10-40mg
daily.
For glucocorticoid remidiable aldosteronism: dexamethasone 1-2mg/day.
However, the response may dissipate over the long term and additional
antihypertensives may be needed.
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