Hyperaldosteronism is a disorder in which the adrenal gland releases too much of the hormone aldosterone into the blood. Hyperaldosteronism can be primary or secondary.

1. Hyperaldosteronism
MohmmadRjab Seder

2. Adrenal Gland

4. Adrenal Gland Hormones

6. Aldosterone
Function:
• Facilitates K+ exchange for Na+ in the
cortical collecting tubules.
Controlled by:
• RAA system.
Na+ reabsorption
K+ and H+ loss.

7. Aldosterone Actions

8. A state of aldosterone level above normal

9. Aldosteronism caused by
autonomous production of
aldosterone by the adrenal
cortex (due to hyperplasia,
adenoma, or carcinoma)
Increased adrenal
production of aldosterone
in response to nonpituitary,
extra-adrenal stimuli such
as renal hypoperfusion
A syndrome featuring
hypokalemia, metabolic
alkalosis, and suppressed
renin in the absence of
elevated aldosterone levels

10. Causes of
Mineralocorticoid
Excess

11. Clinical Features
• Asymptomatic.
• Features of Na+ retention or K+ loss.
• Elevated BP / Persistent HTN.
• Headache, fatigue, weakness.
• Polydipsia, nocturnal polyurea.
• Metabolic alkalosis.

12. Screening Test
Plasma Aldosterone : Renin Ration (ARR) > 30 (or 20) suggests
primary aldosteronism.
Normal plasma aldosterone level: 3–28 pg/mL (in supine position)
Normal plasma renin level: 0.6 to 4.3 ng/mL/hour

13. Diagnosis
• Electrolytes
• Saline infusion test
• Oral sodium loading
To diagnose the cause of primary aldosteronism:
• Imaging: CT, MRI, iodocholesterol scanning, arteriography/venography.
• Adrenal venous sampling (AVS) for ALD level.
• Renin-aldosterone stimulation test.

15. Adrenal Venous Sampling

16. Treatment: Primary Aldosteronism
• Surgical removal of tumors/adenomas.
• Selective aldosterone blocker for hyperplasia.
• Spironolactone 50-100 mg qDay
• Amiloride 5-10 mg qDay
• Eplerenone 50-200 mg q 1 qDay – 2 qDay

17. Treatment: Secondary Aldosteronism
• Treatment of cause.
• Aldosterone antagonists to control HTN:
• Spironolactone 50-100 mg qDay
• Amiloride 5-10 mg qDay
• Eplerenone 50-200 mg q 1 qDay – 2 qDay

18. Practice…
A 35-year-old man is evaluated for poor exercise tolerance and muscle weakness.
He has no past medical history. His blood pressure is 175-185 mmHg systolic and
105-115 mmHg diastolic on repeat measurements. His pulse is 78-95/min. Laboratory
results are as follows:
Sodium 146 mEq/L
Potassium 2.4 mEq/L
Glucose 95 mg/dL
Creatinine 0.7 mg/dL
What is your next step????

19. Answer: CT Scan
CT scan of the abdomen
reveals a 3-cm mass in the
left adrenal gland.
What is your
diagnosis???

20. Answer: Conn’s Syndrome

21. Which of the following additional findings
would be expected in this patient? ? ?
Plasma Renin Activity Serum Aldosterone Serum Bicarbonate
A High High Low
B High High High
C Low High High
D Low High Low
E High Low High

22. What is the next step???
Answer:
Adrenalectomy

24. In Summary
• Diagnosis should be suspected in hypertensive patients with hypokalemia.
• Initial testing includes measurement of plasma aldosterone levels and
plasma renin activity.
• Adrenal imaging tests are done, but often bilateral adrenal vein
catheterization is needed to distinguish tumor from hyperplasia.
• Tumors are removed and patients with adrenal hyperplasia are treated with
aldosterone blockers such as spironolactone or eplerenone.

25. References
• Agabegi, S. (2019). Step-up to medicine (5th ed.). Baltimore, MD: Wolters Kluwer Health.
• Penman, I. D., Ralston, S. H., Strachan, M. W. J., & Hobson, R. (Eds.). (2022). Davidson’s
principles and practice of medicine (24th ed.). London, England: Elsevier Health Sciences.
• G. (n.d.). Primary Aldosteronism - Endocrine and Metabolic Disorders - MSD Manual
Professional Edition. MSD Manual Professional Edition.
https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-
disorders/primary-aldosteronism

26. Sincerely
MohmmadRjab Seder
Palestine Polytechnic University
College of Medicine and Health Sciences
Hebron – Palestine
2023