Hyperaldosteronism: Difference between revisions
 
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* Secondary hyperaldosteronism – due to increased renin from conditions like renal artery stenosis, heart failure, or cirrhosis.
* Secondary hyperaldosteronism – due to increased renin from conditions like renal artery stenosis, heart failure, or cirrhosis.


Primary hyperaldosteronism is an important and potentially reversible cause of secondary hypertension, accounting for 5–10% of hypertensive cases and up to 20% of treatment-resistant hypertension. It is often underdiagnosed in emergency settings.
Primary hyperaldosteronism is an important and potentially reversible cause of secondary hypertension, accounting for 5–10% of hypertensive cases and up to 20% of treatment-resistant hypertension. It is often underdiagnosed in emergency settings. <ref> Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–1916. doi:10.1210/jc.2015-4061 </ref>


==Clinical Features==
==Clinical Features==
 
* Hypertension (often severe or resistant)
*
* Hypokalemia, which may manifest as:
**
** Weakness
**
** Fatigue
**
** Muscle cramps
**
** Constipation
**
** Paresthesia
*
* Polyuria and polydipsia
*
* Metabolic alkalosis (less commonly symptomatic)
*
* Headache or nonspecific complaints
*
* Asymptomatic in some patients


==Differential Diagnosis==
==Differential Diagnosis==
 
* Essential hypertension
*
* Cushing’s syndrome
*
* Pheochromocytoma
*
* Renal artery stenosis
*
* Diuretic or laxative use
*
* Liddle syndrome
*
* Bartter/Gitelman syndromes
*
* Chronic licorice ingestion


==Evaluation==
==Evaluation==
===Workup===
===Workup===
Consider hyperaldosteronism in ED patients with:
* Severe or refractory hypertension
*
* Unexplained hypokalemia
*
* Metabolic alkalosis
Recommended ED labs: <ref> Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607–618. doi:10.1111/j.1365-2265.2007.02775.x </ref>
* Electrolytes (noting hypokalemia and alkalosis)
*
* Creatinine/BUN
*
* ECG (look for U waves, flattened T waves, arrhythmias)
*
* ABG or venous blood gas (if alkalosis suspected)
*
* Urine potassium (if available)


===Diagnosis===
===Diagnosis===
Clinical suspicion in setting of hypertension + hypokalemia
Confirmatory outpatient testing with PAC/PRA ratio
Further endocrinology-guided evaluation determines surgical vs. medical management


==Management==
==Management==
In the Emergency Department:
* Correct hypokalemia (PO or IV potassium)
*
* Avoid ACE inhibitors/ARBs until potassium is corrected
*
* Manage hypertension per usual protocols (IV meds if emergent)
*
* Initiate cardiac monitoring if K⁺ <3.0 mEq/L or if arrhythmia is present


==Disposition==
Admit if:


==Disposition==
* Hypertensive emergency or end-organ damage
*
* Life-threatening hypokalemia or arrhythmia
*
* Severe electrolyte derangements
 
Discharge with outpatient follow-up if:


* Mild symptoms, stable vitals
*
* Newly discovered hypokalemia with controlled BP
*
* Reliable follow-up for endocrine evaluation


==See Also==
==See Also==
[[Hypokalemia]]
[[Hypertensive emergency|Hypertensive Emergency]]
[[Pheochromocytoma]]
[[Hypertension (main)|Renovascular Hypertension]]


[[Cushing's syndrome|Cushing’s Syndrome]]


==External Links==
==External Links==
[https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15026 American Heart Association – Secondary Hypertension Guidelines]


[https://www.ncbi.nlm.nih.gov/books/NBK539779/ NIH – Primary Aldosteronism Overview]


==References==
==References==
<references/>
<references/>

Latest revision as of 23:50, 5 May 2025

Background

Hyperaldosteronism refers to a condition of excess aldosterone secretion, typically leading to sodium retention, potassium excretion, and metabolic alkalosis. It is categorized into:

  • Primary hyperaldosteronism (Conn syndrome) – autonomous overproduction of aldosterone, most commonly from an adrenal adenoma or bilateral adrenal hyperplasia.
  • Secondary hyperaldosteronism – due to increased renin from conditions like renal artery stenosis, heart failure, or cirrhosis.

Primary hyperaldosteronism is an important and potentially reversible cause of secondary hypertension, accounting for 5–10% of hypertensive cases and up to 20% of treatment-resistant hypertension. It is often underdiagnosed in emergency settings. [1]

Clinical Features

  • Hypertension (often severe or resistant)
  • Hypokalemia, which may manifest as:
    • Weakness
    • Fatigue
    • Muscle cramps
    • Constipation
    • Paresthesia
  • Polyuria and polydipsia
  • Metabolic alkalosis (less commonly symptomatic)
  • Headache or nonspecific complaints
  • Asymptomatic in some patients

Differential Diagnosis

  • Essential hypertension
  • Cushing’s syndrome
  • Pheochromocytoma
  • Renal artery stenosis
  • Diuretic or laxative use
  • Liddle syndrome
  • Bartter/Gitelman syndromes
  • Chronic licorice ingestion

Evaluation

Workup

Consider hyperaldosteronism in ED patients with:

  • Severe or refractory hypertension
  • Unexplained hypokalemia
  • Metabolic alkalosis

Recommended ED labs: [2]

  • Electrolytes (noting hypokalemia and alkalosis)
  • Creatinine/BUN
  • ECG (look for U waves, flattened T waves, arrhythmias)
  • ABG or venous blood gas (if alkalosis suspected)
  • Urine potassium (if available)

Diagnosis

Clinical suspicion in setting of hypertension + hypokalemia

Confirmatory outpatient testing with PAC/PRA ratio

Further endocrinology-guided evaluation determines surgical vs. medical management

Management

In the Emergency Department:

  • Correct hypokalemia (PO or IV potassium)
  • Avoid ACE inhibitors/ARBs until potassium is corrected
  • Manage hypertension per usual protocols (IV meds if emergent)
  • Initiate cardiac monitoring if K⁺ <3.0 mEq/L or if arrhythmia is present

Disposition

Admit if:

  • Hypertensive emergency or end-organ damage
  • Life-threatening hypokalemia or arrhythmia
  • Severe electrolyte derangements

Discharge with outpatient follow-up if:

  • Mild symptoms, stable vitals
  • Newly discovered hypokalemia with controlled BP
  • Reliable follow-up for endocrine evaluation

See Also

Hypokalemia

Hypertensive Emergency

Pheochromocytoma

Renovascular Hypertension

Cushing’s Syndrome

External Links

American Heart Association – Secondary Hypertension Guidelines

NIH – Primary Aldosteronism Overview

References

  1. ↑ Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–1916. doi:10.1210/jc.2015-4061
  2. ↑ Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607–618. doi:10.1111/j.1365-2265.2007.02775.x
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