Primary hyperaldosteronism is caused by a physiologic abnormality of the adrenal cortex

  • More common in women ages 30-50
  • S/S:  Arterial HTN, muscle weakness, fatigue, tetany, parasthesia, paralysis, headache, reduced glucose tolerance, metabolic alkalosis, nocturnal polyuria, polydipsia, most ppl are asymptomatic
  • Diagnostic test:  Serum K < 3.5 mEq/L   +  Urinary K > 30 mEq/24 hours
    • Saline loading is used to confirm
  • Treatment of primary hyperaldosteronism:  spironolactone 25-400 mg/day  (agent of choice)
  • For patients with an aldosterone producing adenoma:  do surgery & then supplemental spironolactone
  • Familial primary hyperaldosteronism:  use low dose glucocorticoids & aldosterone antagonist (spironolactone)

Secondary hyperaldosteronism is caused by extra-adrenal factors:  excessive K intake, OCs, prego, menses, CHF, cirrhosis, renal artery stenosis, Bartter’s syndrome (high renin, calciuria, Na/K/Cl transport mutation)

  • Use spironolactone until the cause of the cause of the hyperaldosteronism is identified & can be controlled

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