Primary Aldosteronism
Description
Primary aldosteronism is a secondary cause of hypertension. It is often mistaken for
essential hypertension and often misdiagnosed. A swift and timely diagnosis is crucial to
avoid cardiovascular disease and kidney damage.
Pathophysiology
Excess aldosterone is secreted from one or both adrenal glands, causing renal
reabsorption of water and sodium, causing a person to become hypervolemic,
hypertensive, and hypokalemic. Renin is suppressed as well as angiotensin II which
further affects sodium reabsorption and hypokalemic alkalosis. Autonomous aldosterone
secretion can be due to a hormone-producing adenoma on the adrenal cortex or
Idiopathic adrenal hyperplasia.
Incidence
12% of people with untreated hypertension have primary aldosteronism (Rossi, 2019).
Due to lack of testing and misdiagnosis, it is hard to define the actual number, but it is
believed to be more like 25%. Primary aldosteronism is not more prevalent in any part of
the world. It does occur in women more frequently than men (Amar et al., 2010).
Signs and Symptoms
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Hypertension
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Drug-resistant hypertension
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Hypokalemia
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Muscle cramping
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Cardiac arrhythmias
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Edema
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Metabolic alkalosis
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Cardiovascular disease
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Stroke at an early age (under 40)
Evaluation
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Renin to aldosterone ration blood test. (ARR)
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24-hour urine test
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CT imaging
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Adrenal Vein Sampling
Treatment
Treatment depends on the cause of PA. If it is due to unilateral adrenal hyperplasia or a
unilateral hormone-producing adenoma, then removal of the adrenal gland is the gold
standard. If the PA is bilateral in any way, it will be treated medically with
Mineralocorticoid Receptor Antagonists, specifically spironolactone or eplerenone.
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References
Amar, L., Plouin, P.-F., & Steichen, O. (2010, May 19). Aldosterone-producing adenoma and
other surgically correctable forms of primary aldosteronism. Orphanet journal of rare
diseases. Retrieved July 17, 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889888/
Huang KH;Yu CC;Hu YH;Chang CC;Chan CK;Liao SC;Tsai YC;Jeff Chueh SC;Wu VC;Lin YH; ;
(n.d.). Targeted treatment of primary aldosteronism - the consensus of Taiwan society of
aldosteronism. Journal of the Formosan Medical Association = Taiwan yi zhi. Retrieved
July 17, 2022, from https://pubmed.ncbi.nlm.nih.gov/29506889/
Huether, S. E., McCance, K. L. (20190927). Understanding Pathophysiology, 7th Edition.
[[VitalSource Bookshelf version]]. Retrieved from vbk://9780323672818
Rossi, G. P. (2019). Primary aldosteronism. Journal of the American College of Cardiology,
74(22), 2799–2811. https://doi.org/10.1016/j.jacc.2019.09.057
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