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SECONDARY HYPERTENSION-PRIMARY HYPERALDOSTERONISM

Nephrology

SECONDARY HYPERTENSION-PRIMARY HYPERALDOSTERONISM

1. In the patient with hypokalemia and hypertension, screen for hyperaldosteronism - random plasma aldo­sterone to renin ratio (ratio > 30 is considered positive).

2. Causes - adrenal adenomas (70%; AKA "Conn syndrome"), idiopathic bilateral adrenal hyperplasia (- 25%), adrenal carcinoma is rare.

3. Investigate positive screening test with IV NS (salt & fluid loading) over 3-4 hours and check aldosterone levels. Alternatively, give oral salt load over 3-4 days.

4. Subsequently investigate with CT abdomen.

5. Initial management - salt & fluid restriction, potassium-sparing diuretic.

6. Unilateral adrenal adenomas are surgically removed with excellent results, whereas patients with bilateral adrenal hyperplasia are managed with diuretics alone.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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