Updated: 5/15/2019

Secondary Hyperaldosteronism

Topic
Review Topic
0
0
Snapshot
  • A 32-year-old woman presents to the clinic complaining of a pulsatile headache for the past 2 days. She describes a band-like, 6/10, intermittent pain around her temples. She denies trauma, vision changes, fever, upper respiratory tract infection signs, chest pain, or shortness of breath. Her temperature is 98.6°F (37°C), blood pressure is 164/78 mmHg, pulse is 87/min, and respirations are 12/min. Subsequent laboratory testing reveals a high level of renin (Renal artery stenosis).
Introduction
  • Clinical definition
    • disorder caused by the overactivity of the renin-angiotensin-aldosterone system (RAAS)
  • Epidemiology
    • demographics
      • most commonly caused by renal artery stenosis
  • Pathogenesis
    • reduced renal blood flow
      • decreased renal blood flow stimulates the RAAS with resultant hypersecretion of aldosterone
      • obstructive renal artery disease
        • most commonly due to atherosclerosis
        • fibromuscular dysplasia (in young females)
        • atheroma
      • edematous disorders
        • heart failure
        • cirrhosis
        • nephrotic syndrome
        • chronic renal failure
    • ectopic secretion
      • juxtaglomerular cell tumor
      • other renin-secreting tumors (e.g., adrenal corticoadenoma)
    • Liddle syndrome 
      • rare autosomal dominant condition when there is a gain-of-function mutation in the collecting tubule sodium channel 
Presentation
  • Symptoms
    • fatigue
    • headache
    • weakness (secondary to hypokalemia)
    • paresthesia
    • numbness
    • polyuria (secondary to hypokalemic nephropathy)
    • polydipsia
  • Physical exam
    • hypertension
    • peripheral edema (in severe cases)
    • tetany (due to hypokalemia)
Studies
  • Diagnostic testing
    • diagnostic approach
      • diagnosis is often based on clinical suspicion, especially in patients with resistant hypertension, and confirmed via laboratory testing
    • imaging
      • computed tomography (CT)
        • best initial imaging test to look for masses 
      • magnetic resonance imaging (MRI)
        • more sensitive test  
    • studies
      • ideally, patients should not take any drugs that affect the RAAS (e.g., thiazide diuretics, ACE inhibitors, or angiotensin antagonists) for 4-6 weeks before tests are done
      • 24-hour urine aldosterone
        • best initial test
        • elevated levels suggest hyperaldosteronism
      • plasma renin concentration
        • best initial test, often ordered in conjunction with aldosterone
        • high renin and aldosterone levels suggest secondary hyperaldosteronism
      • basic metabolic/chemistry panels
        • hypokalemia
        • hypernatremia
        • metabolic alkalosis
Differential 
  • Primary hyperaldosteronism 
    • distinguishing factor
      • will have low levels of renin due to the negative feedback mechanism
Treatment
  • Management approach
    • management is focused on treating the underlying cause while treating the hypertension
  • First-line
    • anti-hypertensive therapy
      • spironolactone
        • may lead to gynecomastia
      • epleronone   
        • preferred in men due to its lack of anti-androgenic activity
Complications
  • Hypertensive crisis
  • Kidney damage/failure
  • Heart failure
 

Please rate topic.

Average 5.0 of 3 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note