Primary hyperaldosteronism

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Etiology

  • Solitary adenoma - unilateral (MCC)
  • Bilateral adrenal Hyperplasia

Presentation

  • Hypertension
  • Metabolic alkalosis
  • Hypokalemia
  • Mild hypernatremia
  • NO edema

Diagnosis

  • Screening: High plasma aldosterone, low plasma renin (plasma aldosterone to plasma renin activity (>20)
  • No adrenal suppression after oral saline load confirms dx (?)
  • CT and adrenal venous sampling distinguish between adenoma (unilat) and hyperplasia (bilat)

Treatment

  • Surgery for adenoma
  • Aldosterone antagonists for bilat hyperplasia or poor surgical candidates.
  • Spironolactone: antiandrogen, low libidio, gynecomastia, breast tenderness, menstrual irregularities
  • Eplerenone: selective mineralcocorticoid antagonist