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 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