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Primary Hyperaldosteronism 

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.

Diagnostics: 

  • Hypokalemia
    • 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) 

Treatment:

  • Spironolactone is the mainstay of treatment
  • Laparoscopic surgery can be performed for unilateral adrenal hyperplasia or adrenal adenoma

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