Primary hyperaldosteronism

• Facts:
  Excessive aldosterone secretion from zona glomerulosa
  
  Aldosterone increases sodium and water retention and potassium excretion
• History / PE:
  Hypertension and headache
  Polyuria
  Muscle weakness (from hypokalemia ) and numbness
• Diagnosis:
  Low renin/ aldosterone ratio (< 0.0005)
  Plamsa aldosterone to plasma renin activity ratio (PA:PRA > 30)
  CT scan for adrenal adenoma
  Hypernatremia , hypokalemia
  Metabolic alkalosis
• Treatment:
  Bilateral hyperplasia ( spironolactone )
• Associated With:
  Adrenocortical hyperplasia
  Unilateral adrenal adenoma (Conn's syndrome)
• Differential Diagnosis:
  Renovascular disease (elevated PRA and PA)
  Renin-secretig tumor
  Congenital adrenal hyperplasia
  Chronic black licorice ingestion (low plasma aldosterone levels)
  Bartter's syndrome (urine chloride > 20 mEg/L, normotensive)