QuestionSBA
QuestionChoice
Diabetes insipidus presents with polyuria and polydipsia. The patients are at risk of dehydration, and sodium levels tend to trend towards the upper limit of normal. Potassium and blood pressure are spared (unless there is profound dehydration.) Therefore, diabetes insipidus is not in keeping with the clinical picture of this question.
53244
c
Cranial diabetes insipidus
QuestionChoice
Cushing's syndrome, which occurs due to cortisol excess, may be associated with hypertension, alongside the other classical clinical features of Cushing's such as striae, bruising, and central adiposity (which are absent in this case.) Cortisol has a mild mineralocorticoid effect, which can cause similar changes with a high sodium and low potassium. However, these changes are usually more mild, and in the absence of clinical feature's of Cushing's, this diagnosis remains unlikely.
53246
e
Cushing's syndrome
QuestionChoice
This patient is presenting with hypertension, raised sodium, and low potassium levels, and so the most likely diagnosis is hyperaldosteronism, which results in excess sodium absorption at the expense of potassium and is a secondary cause of hypertension. Muscle weakness and paraesthesiae are precipitated by the electrolyte abnormalities. Conn's syndrome refers to hyperaldosteronism secondary to an adrenal adenoma.
53242
a
Primary hyperaldosteronism
QuestionChoice
Addison's disease is primary adrenal insufficiency, resulting in deficiencies of cortisol and mineralocorticoids. This results in hypotension, low sodium, and raised potassium, which is opposite to the current clinical picture.
53243
b
Addison's disease
QuestionChoice
Secondary hyperparathyroidism is an appropriate response of the parathyroid glands to hypocalcaemia. This patient's calcium levels are within normal range, but this would not necessarily exclude secondary hyperparathyroidism since the PTH may have successfully returned the calcium to normal. A PTH level will be required (which will be inappropriately raised despite the normal calcium) to confirm the diagnosis. However, secondary hyperparathyroidism would not explain the hypertension, the low potassium, or the raised sodium.
53245
d
Secondary hyperparathyroidism
Concept
Chapter
# Summary

Hyperaldosteronism, either primary or secondary, is typically associated with treatment-resistant hypertension and hypokalaemia. Key symptoms include polyuria, polydipsia, lethargy, and headaches, with a noted association with osteoporosis. Causes include adrenal adenoma (Conn's Syndrome), bilateral adrenal hyperplasia, familial hyperaldosteronism, and adrenal carcinoma. Key investigations encompass blood tests such as FBC/UE/LFT, ESR, Bone profile, thyroid function tests, imaging techniques such as chest X-ray and CT/MRI, and notably, aldosterone/renin ratio and selective adrenal venous sampling. The mainstay of management is identifying the underlying cause and if applicable, surgically removing the affected adrenal gland or using medication such as potassium-sparing diuretics for bilateral adrenal disease.

# Definition

Hyperaldosteronism is a medical condition where there is overproduction of aldosterone hormone by the adrenal glands, resulting in fluid retention, high blood pressure, and low serum potassium levels. This condition can be primary (originating from the adrenal glands themselves) or secondary (caused by processes outside the adrenal glands).

NB: Secondary hyperaldosteronism can also occur due to conditions outside the adrenal glands, such as renal artery stenosis, reduced renal perfusion, and increased renin production.

# Epidemiology

Primary hyperaldosteronism is considered the most common form of secondary hypertension, affecting approximately 6-13% of patients with hypertension.

# Aetiology

The causes of hyperaldosteronism include:

- Adrenal adenoma (Conn's Syndrome): Often associated with primary hyperaldosteronism.
- Bilateral adrenal hyperplasia: Common cause of Conn's Syndrome.
- Familial hyperaldosteronism: Rare genetic conditions leading to excessive aldosterone production.
- Adrenal carcinoma: A rare malignant growth within the adrenal gland.

# Signs and Symptoms

Patients with hyperaldosteronism may present with:

- Polyuria: Increased frequency of urination.
- Polydipsia: Increased thirst.
- Lethargy: Persistent tiredness and fatigue.
- Headaches: Often severe and frequent.
- Association with osteoporosis: There is an increased risk of osteoporosis due to excessive excretion of calcium in the urine.

# Differential Diagnosis

Conditions that may mimic hyperaldosteronism include:

- Essential hypertension: Characterised by high blood pressure with no identifiable cause.
- Cushing's syndrome: It includes signs of weight gain, particularly around the waist and face, a rounded "moon" face, thinning skin, and easy bruising.
- Pheochromocytoma: Symptoms can include episodic headaches, sweating episodes, palpitations, and pallor.

# Investigations

To diagnose hyperaldosteronism, the following tests are commonly used:

- First-line:
	- Aldosterone/Renin ratio: A high ratio is suggestive of hyperaldosteronism.
- Second-line:
	- High-Resolution CT (HRCT) or MRI: To locate potential adrenal lesions.
	- Selective adrenal venous sampling: Considered the gold standard for localising the source of excess aldosterone, especially when distinguishing between Conn's Syndrome and bilateral adrenal hyperplasia.

# Management

The management of hyperaldosteronism includes:

- Identifying the underlying cause: Using imaging or selective adrenal venous sampling.
- Surgical intervention: If the excess aldosterone is due to a tumour or lesion, removing the affected adrenal gland may be necessary.
- Medication: In cases of bilateral adrenal disease, medications such as potassium-sparing diuretics (e.g., Amiloride, Spironolactone, Eplerenone) are used to manage the condition.



# References

[Patient.info - Hyperaldosteronism](https://patient.info/doctor/hyperaldosteronism)

[GPnotebook - Conn's syndrome](https://gpnotebook.com/simplepage.cfm?ID=-1335164924)
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2202
Hyperaldosteronism and Conn's syndrome
Topic
36
Clinical Chemistry
10709
A 43-year-old male presents to A&E with muscle weakness and tingling. He says this has occurred intermittently for the past 2 months but he has never consulted a doctor about it. His vitals show a blood pressure of 160/95 mmHg. Blood tests show: 


||||
|---------------------------|:-------:|--------------------|
|Sodium|148 mmol/L|135 - 145|
|Potassium|2.0 mmol/L|3.5 - 5.3|
|Calcium|2.4 mmol/L|2.2 - 2.6|


Which of the following is the most likely diagnosis?
a