Primary aldosteronism is caused by excessive secretion of the hormone aldosterone from the adrenal glands. This can be due to an aldosterone-producing adenoma or adrenal hyperplasia. Symptoms include hypertension, hypokalemia, muscle weakness, and fatigue. Tests used to diagnose include the PAC/PRA ratio, captopril suppression test, saline suppression test, and CT scan. Treatment options are mineralocorticoid receptor antagonists, surgery to remove the adrenal glands, and lifestyle changes like reducing sodium intake. Management involves monitoring blood pressure and electrolyte levels.

1. ALDOSTERONISM
Prepared by: Roxanne Mae E. Birador S.N.

2. LAYERS OF ADRENAL CORTEX

3. ALDOSTERONE
Conserve sodium in the body. It promotes
reabsorption of sodium and elimination of
potassium.
ALDOSTERONISM
excessive secretion of aldosterone

4. (Hyporeninemic Hyperaldosteronism)
Over activity of both adrenal glands
A malignant growth of the outer layer (cortex) of the
adrenal gland (adrenal cortical cancer)

5. (A) Aldosterone producing adenoma;
(B) Micronodular diffuse hyperplasia.

6. Excessive thirst (polydipsia)
Increased urination
(polyuria)
Hypokalemia
Hypernatremia
Muscle weakness
Fatigue
Hypertension

8. • PAC:PRA ratio
The first test used in patients
suspected to have primary
hyperaldosteronism measures the
Plasma Aldosterone Concentration
(PAC) to Plasma Renin Activity (PRA)
Ratio.
A high ratio of PAC to PRA
suggests primary hyperaldosteronism.

9. Captopril Suppression Test
Captopril is a medication for high blood
pressure. A patient is given a single dose of captopril,
after which the levels of aldosterone and renin in the
blood are measured.
In patients with primary hyperaldosteronism, the
level of aldosterone in the blood is still high and the
level of renin is low even after captopril administration.

10. 24-Hour Urinary Excretion of
Aldosterone Test
In the 24-hour urinary excretion of
aldosterone test, a patient eats a high-salt
diet for 5 days before measuring the
amount of aldosterone in the urine over a
24-hour period.
In patients with primary
hyperaldosteronism, aldosterone will not be
suppressed by the salt load, and the level of
aldosterone in the urine will be high.
Saline Suppression Test:
In the saline suppression test, the patient is
given a salt solution through an IV, after which the
levels of aldosterone and renin in the blood are
measured.
In patients with primary hyperaldosteronism, the
level of aldosterone in the blood is still high and the
level of renin is low even after this salt loading.

11. CT scan showing right adrenal adenoma

12. Aldosterone-blocking drugs
(mineralocorticoid receptor
antagonists): DIURETICS
Eplerenone (Inspra)
Spironolactone (Aldactone)

13. • Give daily doses early so that
increased urination does not
interfere with sleep.
• Measure and record regular weight
to monitor mobilization of edema
fluid.
• Avoid giving food rich in potassium.
• Review electrolyte levels.

14. Amlodipine (Norvasc)
Diltiazem (Cardizem, Tiazac)
Felodipine
Isradipine
Nicardipine (Cardene SR)
Nifedipine (Procardia)
Nisoldipine (Sular)
Verapamil (Calan, Verelan)

15. • Take medication
with food or milk.
• Alcohol should be
avoided.

16. Accupril (quinapril)
Aceon (perindopril)
Altace (ramipril)
Capoten (captopril)
Lotensin (benazepril)
Mavik (trandolapril)
Monopril (fosinopril)
Prinivil, Zestril (lisinopril)

17. • Monitor blood pressure and pulse frequently
during initial dose adjustment and
periodically during therapy.
• The drug should be administered 1 hour
before or 2 hours after meals. It may be
crushed if the patient has difficulty
swallowing.

18. Example: K-Lyte
• Take this medication with food or just after
a meal.
• Avoid lying down for at least 30 minutes
after you take this medication.

19. Adrenalectomy a surgical removal of adrenal glands.

20. Advise to low salt diet contains less
than 1,500 mg (1.5 grams) of salt per
day. One teaspoon of salt contains
about 2,300 mg of sodium.
Avoid cooking with salt.
Avoid fast food.
Avoid salty foods.

21. Avoid seasonings that
contain sodium.
Promote exercise, achieve
healthy weight.
Advise smoke cessation.
Avoid alcohol and limit
caffeine.

22. Altered fluid and electrolyte balance
Fluid volume excess related to sodium and water
retention associated with an increased aldosterone level
resulting from activation of the renin-angiotensin-
aldosterone mechanism as a result of decreased renal
blood flow (occurs because of a decrease in intravascular
volume that results from vasodilation and from third-spacing
and sequestration of fluid in the splanchnic system)

23. Decreased cardiac output related to
vasoconstriction
Knowledge deficit related to lack of
information about the disease
process and self-care

24. References:
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Hypertension. Blackwells Science, Oxford. 1994:865-892.Kem DC, Weinberger
M, Gomez-Sanchez C, Kramer NJ, Lerman R, Furuyama S, Nugent CA. Circadian
rhythm of plasma aldosterone concentration in patients with primary
aldosteronism. J Clin Invest 1973;52:2272-2277
Mulatero P, Milan A, Fallo F, Regolisti G, Pizzolo F, Fardella C, Mosso L,
Marafetti L, Veglio F, Maccario M. Comparison of confirmatory tests for the
diagnosis of primary aldosteronism. J Clin Endocrinol Metab 2006;91:2618-
2623.Streeten DH, Tomycz N, Anderson GH. Reliability of screening methods
for the diagnosis of primary hyperaldosteronism. Am J Med 1979;67:403-413.
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