Primary Hyperaldosteronism

00:01 Primary hyperaldosteronism results from the autonomous secretion of excessive aldosterone.

00:06 It is relatively common occurring in approximately 10% of patients with hypertension.

00:12 Clinical features include resistant hypertension, hypokalemia, and metabolic alkalosis.

00:19 Without treatment, excessive cardiovascular morbidity and mortality can occur.

00:24 40% are aldosterone-producing adrenocortical adenomas.

00:30 60% are bilateral adrenal hyperplasia.

00:33 Unilateral adrenal hyperplasia and aldosterone-secreting adrenal carcinomas are very rare.

00:40 Familial hyperaldosteronism is uncommon.

00:43 Once the diagnosis of primary aldosteronism has been confirmed biochemically, radiographic localization with an abdominal CT is indicated.

00:53 CT is recommended over MRI in most cases due to similar efficacy but lower cost with CT.

01:00 Adrenal hyperplasia and adenomas can often be visualized and adrenocortical carcinomas can be ruled out using this modality.

01:10 The goals of treatment are to lower blood pressure.

01:13 Resolution of hypertension, however, is unlikely.

01:17 You also want to improve serum potassium.

01:21 You want to reduce plasma aldosterone even if blood pressure is controlled because elevated levels of aldosterone cause adverse cardiovascular effects.

01:33 The treatment will include laparoscopic adrenalectomy.

01:36 Non-surgical candidates can be treated with mineralocorticoid receptor antagonists.

01:42 Spironolactone is commonly used due to its proven efficacy and cost-effectiveness.

01:47 Eplerenone, a diuretic, is less likely to cause side effects such as the gynecomastia that you see in men from spironolactone and spironolactone-induced menstrual irregularities in women.

02:01 Amiloride is a potassium-sparing diuretic that blocks the aldosterone-sensitive sodium channel.

02:06 Use of amiloride in primary aldosteronism is a second-line therapy because of lower efficacy.