Aldosteronism   Clinical features Causes and Treatment

definition

• Aldosteronism is a syndrome with hypersecretion of mineralocorticoid aldosterone.
• Primary aldosteronism is excessive aldosterone production due to disease of adrenal glands. It is also called nodular hyperplasia or idiopathic hyperaldos­teronism.
• Nonsuppressible (primary) hypersecretion of aldosterone is a underdiagnosed cause of hypertension.
• There is hypokalemia, diastolic hypertension, extra cellular volume expansion, muscle weakness, fatigue, headache, polyuria, polydipsia.
• Secondary aldosteronism is excessive aldosterone production due to extra-adrenal causes. There is al­dosterone secretion in response to activation of renin angiotensin system.
• Aldosterone-producing adenomas Bilateral idiopathic hyperaldosteronism (bilateral adrenal hyperplasia)
• It occurs in accelerated phase of hypertension. Secondary aldosteronism is present in many forms of edema e.g. cirrhosis, nephrotic syndrome, CHF. Arte­rial hypovolaemia stimulates aldosterone secretions resulting in edema.
• Familial hyperaldosteronism type I (glucocorticoid-remediable aldosteronism) and type II (the familial occurrence of aldosterone-producing adenoma or bilateral idiopathic hyperplasia or both).

Aldosteronism Clinical features Causes and Treatment

• HYPOFUNCTION OF THE ADRENAL CORTEX

• Addison’s disease or primary adrenocortical de­ficiency

• It is due to the progressive destruction of adrenals. It may be due to tuberculosis, histoplasmosis, idiopathic atrophy due to autoimmune causes, HIV, bilateral haemorrhage etc.

Clinical features:

• · Weakness
• · Brown pigmentation of skin especially creases
• · Weight loss
• · Anorexia
• · Nausea and vomiting
• · Hypotension
• · Pigmentatio(1 of mucus membrane
• · Pain in abdomen
• · Diarrhoea
• · Constipation
• · Syncope
• · Vitiligo
• · Craving for salt.

Diagnosis:

• • ACTH stimulation test.

Treatment:

• If potassium losses are severe, muscular weakness, cramps, tetany, or cardiac arrhythmias may occur
• Specific hormone replacement to correct both glucocorticoid and mineralocorticoid deficiencies.
• Hydrocortisone is given 20 – 30 mg / day. 2/3^rd of dose is taken in morning and 1/3^rd in after­noon.
• 0.1 mg Fludrocortisone (Mineralocorticoid) is given orally.
• 3-4 g / day of sodium.
• Measurement of blood pressure and serum elec­trolytes is done.
• Female patients may require 50 mg of DHEA orally daily.