An endocrine disorder characterized by excessive production of aldosterone by the adrenal glands. Causes include adrenal gland adenoma and adrenal gland hyperplasia. The overproduction of aldosterone results in sodium and water retention and hypokalaemia. Patients present with high blood pressure, muscle weakness, and headache.It is Usually asymptomaticIt can cause headaches, muscle weakness, fatigue, cramping, polyuria, polydipsia, paraesthesia’s, or tetany (due to the hypokalaemia) there may be a Family history of HTN (early onset, <40 years old).
It is recommended to screen high prevalence group such as resistant hypertension , hypertension with hyperkalaemia , hypertension with adrenal hyperplasia , hypertension with sleep apnoea , hypertension with family history of early onset stroke . or primary hyperaldosteronism.
The screening test is aldosterone renin ratio .in early morning blood sample. Usually aldosterone is high and renin is supressed. It should be done 4-6 weeks after stopping ACEI or angiotensin receptor blockers and spironolactone(MRA) .
Treat HTN and electrolyte abnormalities, particularly hypokalaemia, if present.Surgery is the definitive treatment for unilateral disease .Medical management with aldosterone antagonists is the treatment of choice for bilateral hyperplasia; may be an alternative for patient not interested in surgery or poor surgical candidates
Mineralocorticoid receptor antagonist (MRA): spironolactone, or eplerenone as an alternative. monitor K+ and creatinine frequently during the first 4 to 6 weeks of treatment. Second line treatments includes Other K+-sparing diuretics eg amiloride Antihypertensive agents: CCB, ACE inhibitor, ARB, β-blocker, or low-dose thiazide diuretic are used to control blood pressure . ………..Pubudu