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Hyperaldosteronism
Hyperaldosteronism is a disorder with a characteristic set of signs and symptoms resulting from excessive effects of aldosterone or a similar mineralocorticoid agent, which typically include:
• Hypertension: usually unresponsive to angiotensin converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or direct renin inhibitors
• Intravascular volume expansion
• Hypokalemia
6 Interesting Facts of Hyperaldosteronism
1. Hyperaldosteronism can be either primary (e.g., Conn adenoma, bilateral adrenal hyperplasia) or secondary (renovascular hypertension, sleep apnea). Primary hyperaldosteronism is distinguished by an elevated plasma aldosterone/renin ratio, although the test has frequent false positives.
2. Although exogenous administration of corticosteroids is the most common cause of Cushing syndrome, a basophilic adenoma of the pituitary gland (Cushing disease) is the most common non-iatrogenic cause. It is classically diagnosed by a non-suppressed serum cortisol level after low-dose dexamethasone, but a suppressed serum cortisol level after high-dose dexamethasone.
3. Although many treatments for Cushing syndrome exist, their success largely depends on accurate identification of the overproduced hormone and its source.
4. Congenital adrenal hyperplasia is rarely seen in adults because pediatricians are so efficient at recognizing affected babies and children. For most, low-dose glucocorticoid (and occasional mineralocorticoid) therapy provides effective long-term treatment.
5. Although very rare, patients with pheochromocytoma typically present with hypertension, headaches, and hyperhidrosis (excessive sweating). Patients can be diagnosed with either urinary or plasma catecholamine and/or metabolites. People with pheochromocytoma require pretreatment before surgery with alpha-blockers (and occasional beta-blockade) to prevent a hypertensive crisis. Other family members of patients with features of heredofamilial syndromes should be screened for these diseases.
6. Primary hyperaldosteronism (PA), also known as Conn’s disease, is a clinical syndrome of refractory hypertension (requiring > 3 antihypertensive agents) combined with spontaneous hypokalemia (serum potassium < 3.5 mEq/L) or severe (< 3mEq/L) diuretic-induced hypokalemia. In the vast majority of patients, PA is caused by either bilateral adrenal hyperplasia (60%–65%) or an aldosterone-producing adenoma (APA; 30%–40%).
