View source for SECONDARY HYPERTENSION-PRIMARY HYPERALDOSTERONISM

===== [[Summary Article|'''SUMMARY''']] =====
1. In the patient with hypokalemia and hypertension, screen for hyperaldosteronism: early morning aldosterone:renin ratio (ratio &gt; 30 is considered positive).
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<br/>2. Causes: adrenal adenomas (70%; AKA "Conn syndrome"), idiopathic bilateral adrenal hyperplasia (25%), adrenal carcinoma (rare).
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<br/>3. Investigate positive screening test with IV NS (salt &amp; fluid loading) over 3-4 hours and check aldosterone levels. Alternatively, give oral salt load over 3-4 days.
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<br/>4. Subsequently investigate with CT abdomen.
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<br/>5. Initial management: salt &amp; fluid restriction, potassium-sparing diuretic. 
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<br/>6. Unilateral adrenal adenomas are surgically removed with excellent results, whereas patients with bilateral adrenal hyperplasia are managed with diuretics alone.


==Reference(s)==
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
<br/>Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].

[[Category:Secondary Hypertension]]
[[Category:Nephrology]]
[[Category:Medicine]]