Hyperaldosteronism Questions & Answers

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Questions & Answers

Overview

What is hyperaldosteronism?

What is normal aldosterone physiology?

How is aldosterone synthesized from cholesterol?

What is the pathophysiology of primary hyperaldosteronism?

What is the pathophysiology of familial hyperaldosteronism type I (FH-I)?

What is the pathophysiology of familial hyperaldosteronism type II (FH-II)?

What is the pathophysiology of familial hyperaldosteronism type III (FH-III)?

What is the pathophysiology of secondary hyperaldosteronism?

What is the pathophysiology of hyperaldosteronism in infancy?

What causes primary hyperaldosteronism?

What causes secondary hyperaldosteronism?

Which conditions mimic hyperaldosteronism?

What causes hypokalemia in hyperaldosteronism?

What is the prevalence of hyperaldosteronism?

Which patient groups are at highest risk for hyperaldosteronism?

Which factors affect the prognosis of hyperaldosteronism?

What is the prognosis of primary hyperaldosteronism?

What is the Aldosteronoma Resolution Score (ARS) and how is it used in hyperaldosteronism?

What is the prognosis of hyperaldosteronism in patients with glucocorticoid-remediable aldosteronism (GRA)?

What is the prognosis of hyperaldosteronism in patients with hypokalemia?

What is the role of hyperaldosteronism in diabetic heart disease?

What information about hyperaldosteronism should patients receive?

Presentation

What are symptoms of primary hyperaldosteronism?

What are the hypertension-related symptoms of hyperaldosteronism?

What are the hypokalemia-related symptoms of hyperaldosteronism?

What should be the focus of the clinical history for suspected secondary hyperaldosteronism?

What conditions should be considered in the evaluation of hyperaldosteronism?

What should be included in the exam for hyperaldosteronism?

What are the main complications of primary hyperaldosteronism?

DDX

How is congenital adrenal hyperplasia differentiated from hyperaldosteronism?

What are the possible effects of delayed diagnosis of hypertension in hyperaldosteronism?

Which conditions should be included in the differential diagnoses of primary hyperaldosteronism?

What are diagnostic considerations for secondary hyperaldosteronism?

How is syndrome of apparent mineralocorticoid excess differentiated from hyperaldosteronism?

How is Liddle syndrome differentiated from hyperaldosteronism?

How is gain of function mutation of mineralocorticoid receptor (MR) differentiated from hyperaldosteronism?

How is glucocorticoid resistance differentiated from hyperaldosteronism?

How is drug-induced apparent mineralocorticoid excess differentiated from hyperaldosteronism?

What are the differential diagnoses for Hyperaldosteronism?

Workup

Which patients should be screened for primary hyperaldosteronism?

What is the role of aldosterone-to-renin ratio (ARR) in the diagnosis of hyperaldosteronism?

Which factors can affect the interpretation of aldosterone-to-renin ratio (ARR) results in the workup of hyperaldosteronism?

Which medications may influence the results of aldosterone-to-renin ratio (ARR) in the workup of hyperaldosteronism?

How is a diagnosis of primary hyperaldosteronism confirmed?

How is a saline infusion test performed in the workup of hyperaldosteronism?

How is the oral salt loading test performed in the workup of hyperaldosteronism?

How is the captopril test performed in the workup of hyperaldosteronism?

How is the fludrocortisone suppression test performed in the workup of hyperaldosteronism?

How is postural testing performed in the workup of primary hyperaldosteronism?

What is the role of 18-hydroxycorticosterone measurement in the workup of primary hyperaldosteronism?

What is the role of a dexamethasone suppression test in the workup of primary hyperaldosteronism?

What is the role of adrenal imaging in the workup of hyperaldosteronism?

What is the role of CT scan in the workup of hyperaldosteronism?

What is the role of scintigraphy in the workup of hyperaldosteronism?

What is the role of adrenal venous sampling (AVS) in the workup of primary hyperaldosteronism?

How is adrenal venous sampling (AVS) performed in the workup of hyperaldosteronism?

What are possible complications of adrenal venous sampling (AVS) in the workup of hyperaldosteronism?

What are histologic findings characteristic of hyperaldosteronism?

Treatment

What are the treatment options for hyperaldosteronism?

How are hypokalemia and hypertension managed in idiopathic hyperaldosteronism (IHA)?

What is the role of spironolactone in the treatment of idiopathic hyperaldosteronism?

What causes differences in response to spironolactone in the treatment of idiopathic hyperaldosteronism?

What is the most adverse effect of mineralocorticoid receptor antagonist therapy for idiopathic hyperaldosteronism?

What is the role of canrenone in the treatment of idiopathic hyperaldosteronism?

What are alternatives to spironolactone in the treatment of idiopathic hyperaldosteronism?

What is the role of pharmacologic therapy for familial hyperaldosteronism type I (FH-I)?

What is the role of pharmacologic therapy for familial hyperaldosteronism type II (FH-II)?

What is the role of pharmacologic therapy for familial hyperaldosteronism type III (FH-III)?

What medical treatments are being investigated for the treatment of hyperaldosteronism?

What is the role of surgery in the treatment of hyperaldosteronism?

What does persistent hypertension indicate despite control of hyperaldosteronism indicate?

How are complications of adrenalectomy and adenomectomy for hyperaldosteronism managed?

What is the role of imaging-guided ablation of the adrenal glands in the treatment of hyperaldosteronism?

What are dietary restrictions for the treatment of hyperaldosteronism?

What are activity restrictions for the treatment of hyperaldosteronism?

Which specialist consultations are needed for the treatment of hyperaldosteronism?

What is included in long-term monitoring of hyperaldosteronism?

Medications

Which medications are used in the treatment of hyperaldosteronism?

Which medications in the drug class Antihypertensives, Other are used in the treatment of Hyperaldosteronism?

Which medications in the drug class Diuretics, Potassium-Sparing are used in the treatment of Hyperaldosteronism?

Which medications in the drug class Aldosterone Antagonists, Selective are used in the treatment of Hyperaldosteronism?

Follow-up

What follow-up care should be provided to patients with hyperaldosteronism?

Which medications are indicated for the treatment of hyperaldosteronism?

When is transfer indicated in patients with hyperaldosteronism?