00:01
Primary hyperaldosteronism
results from
the autonomous secretion
of excessive aldosterone.
00:06
It is relatively
common
occurring in approximately 10%
of patients with hypertension.
00:12
Clinical features include
resistant hypertension,
hypokalemia,
and metabolic alkalosis.
00:19
Without
treatment,
excessive cardiovascular morbidity
and mortality can occur.
00:24
40% are aldosterone-producing
adrenocortical adenomas.
00:30
60% are bilateral
adrenal hyperplasia.
00:33
Unilateral adrenal
hyperplasia
and aldosterone-secreting adrenal
carcinomas are very rare.
00:40
Familial hyperaldosteronism
is uncommon.
00:43
Once the diagnosis of primary aldosteronism
has been confirmed biochemically,
radiographic localization with an
abdominal CT is indicated.
00:53
CT is recommended over MRI in
most cases due to similar efficacy
but lower cost
with CT.
01:00
Adrenal hyperplasia and adenomas
can often be visualized
and adrenocortical carcinomas can be
ruled out using this modality.
01:10
The goals of treatment are
to lower blood pressure.
01:13
Resolution of hypertension,
however, is unlikely.
01:17
You also want to improve
serum potassium.
01:21
You want to reduce plasma aldosterone
even if blood pressure is controlled
because elevated levels of aldosterone cause
adverse cardiovascular effects.
01:33
The treatment will include
laparoscopic adrenalectomy.
01:36
Non-surgical candidates
can be treated
with mineralocorticoid
receptor antagonists.
01:42
Spironolactone is
commonly used
due to its proven efficacy
and cost-effectiveness.
01:47
Eplerenone, a diuretic, is less likely
to cause side effects
such as the gynecomastia that you see
in men from spironolactone
and spironolactone-induced
menstrual irregularities in women.
02:01
Amiloride is a
potassium-sparing diuretic
that blocks the aldosterone-sensitive
sodium channel.
02:06
Use of amiloride in primary aldosteronism
is a second-line therapy
because of
lower efficacy.