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  • hyperaldosteronism is due to excessive aldosterone secretion from the adrenals and causes hypertension with hypokalaemia and metabolic alkalosis
  • it is characterized by a high serum level of aldosterone and a low serum renin level if primary and a high serum renin level is secondary
  • the same clinical features but with normal or low levels of aldosterone may be caused by pseudoaldosteronism which may be due to:
    • licorice ingestion
      • licorice inhibits the 11-beta hydroxysteroid dehydrogenase type II (Protein:HSD11B2) enzyme resulting in inappropriate stimulation of the mineralocorticoid receptor by cortisol
    • high gluocorticosteroid levels
    • Liddle's syndrome (an extremely rare genetic disorder)


primary hyperaldosteronism

  • note: serum renin levels will be low
  • idiopathic bilateral adrenal cortical hyperplasia (70% of cases)
  • adrenal adenoma
    • Conn's syndrome
    • large aldosterone-secreting adrenal adenomas
      • tend to be picked up on CT scans given their larger size
      • tend to have pathogenic KCNJ5 variants (30-40% of large aldosterone-secreting adrenal adenomas)
      • cells paradoxically resemble the cortisol- rather than aldosterone-secreting zone of the normal adrenal gland
    • ZG-like aldosterone-secreting adrenal adenomas
      • tend to have pathogenic CACNA1D, ATP1A1 and ATP2B3 variants
      • tend to be smaller and missed on CT scans
      • cells resemble the physiological aldosterone-secreting cells of the adrenal zona glomerulosa (ZG)
    • daily transient adrenal adenoma hyper-aldosteronism
      • discovered in 2023 1)
        • requires 24hr urine aldosterone to detect as serum levels may miss the transient rises
        • caused by a somatic mutation in aldosterone-producing adenomas of the gene which produces a protein called cell adhesion molecule 1 (CADM1)
        • seems to the the cause of 5-10% of cases of hypertension
        • Rx is unilateral adrenalectomy
  • adrenal carcinoma is an extremely rare cause
  • glucocorticoid remediable aldosteronism (aldosterone synthase hyperactivity), is an autosomal dominant disorder in which the increase in aldosterone secretion produced by ACTH is no longer transient.

secondary hyperaldosteronism

  • this is due to overactivity of the renin–angiotensin–aldosterone system (RAAS) resulting from high renin levels
    • massive ascites
    • cor pulmonale
    • a renin-producing tumor leads to increased aldosterone eg. juxtaglomerular cell tumor
    • renal artery stenosis causes reduced blood supply across the juxtaglomerular apparatus which stimulates the production of renin
    • hyporeabsorption of sodium (as seen in Bartter and Gitelman syndromes)


  • elevated serum aldosterone
  • serum aldosterone:renin ratio to determine primary vs secondary
  • serum cortisol to exclude cortisol causes
hyperaldosteronism.txt · Last modified: 2023/06/12 10:05 by gary1

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