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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Primary hyperaldosteronism (With high levels of renin and aldosterone levels)
Idiopathic bilateral adrenal hyperplasia
Conn's syndrome : Aldosterone producing adrenal tumour
Glucorticoid suppresible hyperaldosteronism
Secondary hyperaldosteronism (With renin low or high aldosterone levels)
Renal artery stenosis
Diuretic therapy
cardiac failure
Liver failure
Nephrotic syndrome
With renin low and aldosterone low (Non aldosterone dependent activation of mineralocorticoid pathway)
Ectopic ACTH syndrome
Liddle's syndrome
11- deoxycorticosterone secreting adrenal tumour
Clinical feature
Muscle weakness due to hypokalemia
Pedal edema due to sodium retention.
Hypertension
Polyuria
Tetany due to assosciated metabolic alkalosis and low ionised calcium.
Investigation
Electrolytes
Hypokalemia
Sodium is towards the upper level in primary hyperaldosteronism ; towards the lower end in case of secondary hyperaldosteronism.
Renin and aldosterone levels are checked .
Patient should be off betablockers (inhibit renin secretion ) , thiazide diuretics (stimulates renin secretion)
Potassium levels should be corrected prior because hypokalemia can supress renin activity.
CT/ MRI abdomen to look for tumours.
Management
Mineralocorticoid receptor antagonist like spirinolactone , eplerenone or amiloride is used.
Liddle's Syndrome
Liddle syndrome is a state of aldosterone excess by the presence of early and severe hypertension.
Asstd. With hypokalemia and metabolic alkalosis but low aldosterone and renin levels.
It is due to genetic defect causing overactivity of epithelial sodium channel in the distal nephron.
Reference
Davidson's principle & practice of medicine
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor