Aldosteronism

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  1. Aldosterone is the most potent mineralocorticoid produced by the adrenals – causes Na retention and K loss
  2. Hyperaldosteronism can be caused by a tumor (usually benign adenoma) of the adrenal gland- condition called Conn's syndrome, or can be secondary to other diseases such as hypertension, congestive heart failure, renal artery stenosis, hepatic cirrhosis, or ectopic production of aldosteron from another tumor
  3. Aldosterone production is regulated partly by corticotropin (secreted by the pituitary gland) and partly through the renin-angiotensin-aldosterone system
  4. Hyperaldosteronism may lead to hypernatremia and hypertension
  5. In the distal tubule, aldosterone causes the exchange of Na for K and H, which in elevated states can cause a hypokalemic alkalosis with weakness, paresthesias, paralysis, tetany and hypertension
    1. Reduction in blood volume increases secretion of renin, renin transforms angiotensinogen to angiotensin I which is converted to angiotensin II – angiotensin II causes secretion of aldosterone
  6. diagnosis: Computed tomography (CT) or magnetic resonance imaging (MRI) of the adrenals can be helpful, but sometimes blood samples from each of the adrenals must be tested to determine the source of the hormone.
  7. Treatment: surgical removal of the adrenal adenoma or tumor with ectopic aldosteron production; subtotal adrenalectomy (if no adenoma is found and both adrenals are hyperactive)
  8. Medical treatment includes: aldosteron action antagonists ( spironolactone or eplerenone), antihypertensives
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