Hyperaldosteronism
| Hyperaldosteronism | |
|---|---|
 | |
| Classification and external resources | |
| ICD-10 | E26 |
| ICD-9 | 255.1 |
| OMIM | 103900 605635 |
| DiseasesDB | 6187 |
| MedlinePlus | 000330 |
| eMedicine | radio/354 |
| Patient UK | Hyperaldosteronism |
| MeSH | D006929 |
Hyperaldosteronism, also aldosteronism,[1] is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalemia).
Signs and symptoms
It can be asymptomatic, but these symptoms may be present:
- Fatigue
- Headache
- High blood pressure
- Hypokalemia
- Hypernatraemia
- Hypomagnesemia
- Intermittent or temporary paralysis
- Muscle spasms
- Muscle weakness
- Numbness
- Polyuria
- Polydipsia
- Tingling
- Metabolic alkalosis[2]
Types
In endocrinology, the terms 'primary' and 'secondary' are used to describe the abnormality (e.g., elevated aldosterone) in relation to the defect, i.e., the tumor's location.
Primary
Primary aldosteronism (hyporeninemic hyperaldosteronism) was previously thought to be most commonly caused by an adrenal adenoma, termed Conn's syndrome. However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is the cause in up to 70% of cases. Differentiating between the two is important, as this determines treatment. Also see congenital adrenal hyperplasia. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism. Two familial forms have been identified: type I ( dexamethasone suppressible ) and type II (that has been linked to 7p22.[3] )
Features
- Hypertension
- Hypokalemia (e.g., may cause muscle weakness)
- Alkalosis
Investigations
- High serum aldosterone
- Low serum renin
- High-resolution CT abdomen
Management
- Adrenal adenoma: surgery
- Bilateral adrenocortical hyperplasia: aldosterone antagonist, e.g., spironolactone
Secondary
- Secondary hyperaldosteronism (also hyperreninism, or hyperreninemic hyperaldosteronism) is due to overactivity of the renin-angiotensin-aldosterone system (RAAS).
Secondary refers to an abnormality that indirectly results in pathology through a predictable physiologic pathway, i.e., a renin-producing tumor leads to increased aldosterone, as the body's aldosterone production is normally regulated by renin levels.
One cause is a juxtaglomerular cell tumor. Another is renal artery stenosis, in which the reduced blood supply across the juxtaglomerular apparatus stimulates the production of renin. Also, fibromuscular hyperplasia may cause secondary hyperaldosteronism. Other causes can come from the tubules: Hyporeabsorption of sodium (as seen in Bartter and Gitelman syndromes) will lead to hypovolemia/hypotension, which will activate the RAAS.
Diagnosis
When taking a blood test, the aldosterone-to-renin ratio is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin in secondary hyperaldosteronism.
Treatment
Treatment includes spironolactone, a potassium-sparing diuretic that works by acting as an aldosterone antagonist.
See also
References
- ↑ "aldosteronism" at Dorland's Medical Dictionary
- ↑ "Hyperaldosteronism: eMedicine Pediatrics: General Medicine". Retrieved 2009-06-16.
- ↑ Lafferty AR, Torpy DJ, Stowasser M et al. (November 2000). "A novel genetic locus for low renin hypertension: familial hyperaldosteronism type II maps to chromosome 7 (7p22)". J. Med. Genet. 37 (11): 831–5. doi:10.1136/jmg.37.11.831. PMC 1734468. PMID 11073536.
External links
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||