Aldosteronism   Clinical features Causes and Treatment


  • 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 1

Aldosteronism Clinical features Causes and Treatment

  • 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.


  • • ACTH stimulation test.


  • 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. 2/3rd of dose is taken in morning and 1/3rd 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.



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