Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Hypertension with or without hypokalemia• Elevated aldosterone secretion and suppressed plasma renin activity• Metabolic alkalosis, relative hypernatremia• Weakness, polyuria, paresthesias, tetany, cramps due to hypokalemia• Common subtypes of primary hyperaldosteronism: aldosteronoma (75%) and bilateral adrenal hyperplasia (25%)• Rare subtypes of primary hyperaldosteronism: unilateral primary adrenal hyperplasia, aldosterone producing adrenocortical carcinoma, glucocorticoid-remediable hyperaldosteronism (familial hyperaldosteronism type 1) +++ Epidemiology + • 1% of patients with hypertension• 8% of normokalemic hypertensive patients +++ Symptoms and Signs + • Hypertension• Headaches• Malaise• Muscle weakness• Polyuria• Polydipsia• Cramps• Paresthesias• Hypokalemic paralysis (rare) +++ Laboratory Findings + • Hypokalemia• Hypernatremia• Metabolic alkalosis• Elevated plasma aldosterone to renin ratio (> 20)• Elevated plasma aldosterone concentration (> 15 ng/dL)• Elevated urine/serum aldosterone level with PO or IV sodium challenge +++ Imaging Findings + • CT scan with thin sections through adrenals can identify most adenomas• Adrenal vein sampling if CT is equivocal• MRI can be used as well to identify an adrenal tumor + • Aldosteronoma and rare unilateral primary adrenal hyperplasia are the most amenable types of primary hyperaldosteronism to surgical correction +++ Rule Out + • Pheochromocytoma + • Thorough history and physical exam• Confirmed hypertension (multiple measurements)• Laboratory evaluation (electrolytes, serum aldosterone, and renin levels)• Cross sectional imaging (CT, MRI)• Possible bilateral adrenal vein sampling + • Goal is to prevent illness associated with hypertension and hypokalemia• Surgical therapy for patients with aldosteronoma and unilateral primary adrenal hyperplasia• Medical therapy for bilateral adrenal hyperplasia, or poor surgical candidates• Preoperative preparation is key, with control of blood pressure and serum potassium +++ Surgery + • Nearly always laparoscopic approach +++ Indications + • Unilateral aldosteronoma• Unilateral primary adrenal hyperplasia +++ Contraindications + • Bilateral adrenal hyperplasia +++ Medications + • Spironolactone: Competitive aldosterone antagonist• Amiloride: Potassium-sparing diuretic• Other antihypertensive agents such as ACE inhibitors and calcium channel blockers +++ Treatment Monitoring + • Monitor blood pressure +++ Complications + • Uncontrolled hypertension can lead to renal failure, stroke, or myocardial infarction• Severe hypokalemia can lead to paralysis; risk of cardiac dysrhythmia increases in combination with digitalis +++ Prognosis + • Removal of aldosteronoma normalizes potassium, but hypertension is not always cured• 33% of patients have persistent, mild hypertension (easier to control than before operation) +++ References ++Al Fehaily M, Duh QY: Clinical manifestation of aldosteronoma. Surg Clin North Am 2004;84:887. ++Magill SB et al: Comparison of adrenal vein ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.