Hyperaldosteronism

Definition

Hyperaldosteronism is a condition characterized by excessive secretion of aldosterone from the adrenal glands, leading to sodium retention, potassium excretion, hypertension, and volume expansion. It can be primary (adrenal origin) or secondary (renin-driven).

Epidemiology

• Primary hyperaldosteronism accounts for 5–10% of hypertensive patients
• More common in adults aged 30–50 years
• Slight female predominance for idiopathic hyperaldosteronism; adrenal adenomas are more common in females
• Secondary hyperaldosteronism occurs with conditions like renal artery stenosis, heart failure, or cirrhosis

Etiology

• Primary hyperaldosteronism: adrenal adenoma (Conn’s syndrome), bilateral adrenal hyperplasia, adrenal carcinoma (rare), familial hyperaldosteronism types I–III
• Secondary hyperaldosteronism: renal artery stenosis, congestive heart failure, cirrhosis, nephrotic syndrome, high renin states

Pathophysiology

• Excess aldosterone → increased sodium reabsorption and potassium excretion in renal distal tubules
• Sodium retention → volume expansion → hypertension
• Potassium depletion → hypokalemia → muscle weakness, metabolic alkalosis
• Suppression of renin in primary hyperaldosteronism; renin elevated in secondary forms
• Chronic effects: cardiovascular remodeling, left ventricular hypertrophy