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  1. Primary hyperaldosteronism is excess production of aldosterone, independent of the renin-angiotensin system, causing sodium and water retention, and renin release.

Causes of primary hyperaldosteronism

  1. Adrenal adenoma (Conn’s syndrome)- Usually unilateral. It is the most common cause of primary hyperaldosteronism.
  2. Adrenal carcinoma:

MCQ: In Conn syndrome Polyuria occur Because of hypokalemia which leads to nephrogenic diabetes insipidus. 

  1. Bilateral adrenal cortical hyperplasia 

Clinical features of Conn’s syndrome :

  1. Weakness, cramps, paraesthesia,
  2. Polyuria, polydipsia.
  3. Hypernatremia
  4. Hypertension
  5. Hypokaliemia :-  Ventricular arrhythmia,  Muscle wasting (Proximal myopathy), Impaired concentrating ability of kidney due to hypokaliemia causes polyuria, Polydipsia.
  6. Metabolic Alkalosis

Extra Edge: Oedema feet is not a feature of primary hyperaldosteronism & SIADH (LQ 2012)



  1. Primary hyperaldosteronism
    1. ↑ Aldosterone
    2. Renin
  2. Secondary hyperaldosteronism
    1. in Renin
    2. Aldosterone   

Extra Edge: In Addison disease Renin and Aldosterone

Recent Advances: Primary Aldosteronism

  1. The ratio of plasma aldosterone to plasma renin activity (PA/PRA) is a useful screening test.
  2. Bilateral adrenal venous sampling for measurement of plasma aldosterone is the most accurate means of differentiating unilateral from bilateral forms of primary aldosteronism.
  3. The sensitivity and specificity of adrenal venous sampling (95% and 100%, respectively) for detecting unilateral aldosterone hypersecretion are superior to those of adrenal CT.

Renin - Aldosterone Axis Assay





Renin stimulation test

40 mg furosemide is administered; then plasma renin is measured in both supine and upright positions

No stimulation of renin levels in upright position indicates renin suppression

Aldosterone suppression test

1-2 L of saline are infused; then plasma aldosterone is measured in both supine and upright positions

Lack of aldosterone suppression to below normal may indicate primary aldosterone overproduction

Plasma aldosterone-to-renin ratio

Serum renin and aldosterone levels are measured

Value greater than 15 is highly suggestive of primary hyperaldosteronism

Bilateral renal venous renin; adrenal venous aldosterone and cortisol concentrations


Hypertension of aldosteronoma is responsive to tumor removal (hypertension associated with bilateral disease is not)



  1. Conn’s : Adrenalectomy.
  2. Hyperplasia: Treated medically: spironolactone, Eplerenone
  1. Secondary hyperaldosteronism
    1. Renal artery stenosis       
    2. Accelerated hypertension     
    3. CCF    
    4. Hepatic failure      
    5. Nephrotic syndrome

Treatment: Spironolactone, Eplerenone


Recent Advances:

Eplerenone: A new selective aldosterone receptor antagonist, which does not cause gynecomastia (PQ)

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