Hyperaldosteronism is a clinical disorder caused by excessive secretion of the hormone aldosterone by the adrenal glands.
Aldosterone is a hormone that plays its role mainly in the kidney which removes sodium and potassium retained, while increasing the volume of fluid circulating in the blood (hypervolemia).
The kidney, as compared to stimuli little blood or blood sodium decreased releases renin, which acts on a blood protein released by the liver, angiotensinogen. By action of renin on angiotensinogen produces angiotensin I is that the effect of ACE (protein found in the pulmonary arteries), produces angiotensin II.Angiotensin II stimulates the production of aldosterone by the adrenal glands.
The mechanism by which an increase in aldosterone depends different causes. The causes are due to alterations of the gland are the primary aldosteronism: benign tumors (adenomas) and malignant adrenal glands, adrenal hyperplasia, or unknown causes. The most common form is usually the cortical adenoma (Conn’s syndrome).
Other causes of increased aldosterone is due to stimuli originating outside of the gland, are secondary hyperaldosteronism. Included Bartter syndrome, stenosis (narrowing) of the renal artery, renal tumors, heart failure.
In primary hyperaldosteronism, most symptoms are due to the fact that aldosterone excess has on the regulation of the levels of sodium and potassium. As aldosterone causes sodium and fluid retention in the kidney, when there is more of the hormone will appear high blood pressure, lowering blood potassium (hypokalemia). Hypokalemia causes symptoms such as muscle weakness, fatigue and cramps, and may cause serious cardiac arrhythmias. Other symptoms, paradoxical, that may appear are the increased volume of urine (polyuria) and excessive water intake (polydipsia). In the case of a patient without concomitant diseases, increased blood volume of liquid can be well tolerated. However if there are other diseases as renal impairment, or heart failure, may be a major cause fluid retention and edematous disorders that manifest as swelling of regions declines as the feet and legs.
In secondary hyperaldosteronism symptoms may vary from the referred for primary hyperaldosteronism. For example, in the Bartter syndrome are usually lower blood pressure and is often associated with edema.
Diagnosis begins with clinically suspected in a patient with hypertension and detecting a low blood potassium (hypokalemia) and high sodium (hypernatremia). In mild forms of primary aldosteronism potassium levels may be normal. If hypokalemia is severe, also descend blood magnesium levels.
Given these changes, it will request the levels of aldosterone and renin in the blood. There will decrease renin and aldosterone hypersecretion.
Imaging techniques, especially MRI and CT can detect tumors (adenomas and other adrenal tumors).
The treatment can be with drugs or by surgery in selected cases. Overall correct pursued hypertension and alterations ionic (sodium and potassium) and metabolic (hyperglycemia). For the treatment of hypertension used sparing diuretics such as spironolactone and amiloride.
In the case of an adrenal tumor must normalize blood pressure and hypokalemia before surgery with low-sodium diet, spironolactone and potassium supplements.
Bartter’s syndrome symptomatology is controlled with spironolactone, propranolol, enalapril, supplementation of potassium and magnesium, proper diet, and glucocorticoids (such as dexamethasone).
As for surgical treatment can be a surgical removal of the adenoma. Other tumors may require more aggressive surgery and radiotherapy plus chemotherapy.
The best prevention is to control blood pressure values and, given the existence of hypertension, search for data that may suggest the existence of an adrenal disorder.
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