Background: Excess aldosterone secretion from the adrenal cortex. Most common cause of primary hyperaldosteronism is bilateral adrenal hyperplasia.
Clinical Presentation: Refractory hypertension in young or middle aged adults commonly failing multiple anti-hypertensive drug regimens. Associated symptoms include headaches, fatigue, flushing and excess sweating.
- Metabolic alkalosis may be present due to counter exchange of potassium and hydrogen in the kidneys
- Plasma aldosterone concentration (PAC) to plasma renin assay (PRA) ratio
- PAC/PRA ratio of > 20
- PAC is often greater than 15 ng/dL
- Confirmatory test: 24 urine aldosterone >20 mcg/24hrs
- MRI or CT scan can be used to differentiate adrenal hyperplasia from an adrenal adenoma (Conn Syndrome)
- Spironolactone is the mainstay of treatment
- Laparoscopic surgery can be performed for unilateral adrenal hyperplasia or adrenal adenoma