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Aldosteronism, Primary

Vicente T. San Martin, MD and Rodolfo J. Galindo, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Clinical syndrome of excess aldosterone production, independent of renin secretion, and nonsuppressible by sodium (Na+) loading

  • Classically manifested by hypertension (HTN) and hypoka...

DIAGNOSIS

HISTORY

  • Usually asymptomatic

  • ROS: headaches, muscle weakness, fatigue, cramping, polyuria, polydipsia, paresthesias, or tetany (due to the hypokalemia)

  • Family history of HTN (early onset, <4...

TREATMENT

  • Treat HTN and electrolyte abnormalities, particularly hypokalemia, if present.

  • Surgery is the definitive treatment for unilateral disease (5)[A].

  • Medical management with aldosterone antagonist...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • K+ supplements, anti-HTN therapy, and spironolactone may need to be stopped/decreased after surgery.

  • High Na+ diet may be needed to avoid the hyperkalemia that can...

REFERENCES

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 Endocrino...

ADDITIONAL READING

  • Dekkers T, Prejbisz A, Kool LJS, et al; for SPARTACUS Investigators. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomize...

CODES

ICD10

  • E26.09 Other primary hyperaldosteronism

  • E26.01 Conn's syndrome

  • E26.81 Bartter's syndrome

  • E26.02 Glucocorticoid-remediable aldosteronism

ICD9

  • 255.10 Hyperaldosteronism, unspecified

  • 255.12 Conn's s...

CLINICAL PEARLS

  • Screening for PA is recommended in high-risk patients.

  • Calculate ARR in patients at increased risk.

  • Confirmed cases should undergo high-resolution CT scan to exclude ACC.

  • If surgery is de...

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