An aldosterone producing tumor of the adrenal cortex is the main cause of primary hyperaldosteronism
and should always be excluded when in the presence of severe hypertension, since the standard treatment is surgical and leads to a stabilization of the tension pattern after a few months.
Platt versus Pickering: what molecular insight to primary hyperaldosteronism
tells us about hypertension.
The vascular surgeon's experience with adrenal venous sampling for the diagnosis of primary hyperaldosteronism
. Ann Vasc Surg 2014; 28:1266-1270.
 Here hyperaldosteronism
occurs, but with a low or low-normal plasma aldosterone and renin level.
Presently, the only constellation resulting in appropriately low renin values is sodium- or volume-dependent hypertension, as classically found in primary hyperaldosteronism
Type II of familial hyperaldosteronism
was first described in an Australian family 25 years ago.
High blood pressure and kidney dysfunction have reciprocal effects: high blood pressure induces damage to renal vessels via vessel stretch; in contrast, kidney impairment leads to fluid accumulation in vessels, improper excretion, hyperaldosteronism
, and elevated sodium reabsorption, and these defects then raise blood pressure.
Urinary losses Diuretics Hypomagnesaemia Bartter and Gitelman syndromes Gastrointestinal losses Vomiting Diarrhoea or laxative abuse Decreased potassium intake Poor oral intake Hyperaldosteronism
The causes of hypokalemia include decreased distal tubular Na+ delivery, secondary hyperaldosteronism
, defective H+-K+ ATPase, and bicarbonaturia.
Weber, "Anti-aldosterone treatment and the prevention of myocardial fibrosis in primary and secondary hyperaldosteronism
," Journal of Molecular and Cellular Cardiology, vol.
Uncontrolled hypertension, chlorideresistant metabolic alkalosis, and hypokalemia prompted the workup for hyperaldosteronism
. Serum aldosterone and plasma renin activity were within normal limits.
The transtubular potassium gradient was mildly increased (TTKG 11, normal value 5-10), suggesting a secondary hyperaldosteronism
as a consequence of volume depletion.
She was not hypertensive, and there was no evidence of primary hyperaldosteronism
JGCT is a renin-producing tumor, which causes hypertension, hyperaldosteronism
, and hypokalemia.
PA can be caused by idiopathic unilateral or bilateral adrenal hyperplasia, aldosterone-producing adenomas (APAs), pure aldosterone-producing adrenocortical carcinomas, familial hyperaldosteronism
, and, in rare cases, by ovarian tumors.