Primary hyperaldosteronism history and symptoms: Difference between revisions
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{{CMG}}; {{AE}} {{HK}} | {{CMG}}; {{AE}} {{HK}} | ||
==Overview== | ==Overview== | ||
The hallmark of primary hyperaldosteronism is resistant [[hypertension]]. A positive history of | The hallmark of primary hyperaldosteronism is resistant [[hypertension]]. A positive history of spontaneous or unprovoked [[hypokalemia]] and treatment-resistant (refractory) [[hypertension]] are suggestive of primary hyperaldosteronism. The most common [[symptoms]] of primary hyperaldosteronism include [[Headache|headaches]], [[facial flushing]], vision changes, and [[Muscle weakness|weakness]]. | ||
==History == | ==History and Symptoms == | ||
Primary hyperaldosteronism may be suspected in the following scenarios: | Primary hyperaldosteronism may be suspected in the following scenarios: | ||
* Patients with a history of spontaneous or unprovoked [[hypokalemia]] along with [[hypertension]]. | * Patients with a history of spontaneous or unprovoked [[hypokalemia]] along with [[hypertension]]. | ||
* Patients who develop severe and/or persistent [[hypokalemia]] while on low to moderate doses of [[Diuretics|potassium-wasting diuretics]]. | * Patients who develop severe and/or persistent [[hypokalemia]] while on low to moderate doses of [[Diuretics|potassium-wasting diuretics]]. | ||
* Patients with a history of treatment-refractory | * Patients with a history of treatment-refractory (resistant) [[hypertension]] (HTN). | ||
Patients with profound [[hypokalemia]] report [[fatigue]], [[muscle weakness]], [[cramping]], [[headaches]], and [[palpitations]]. They can also have [[polydipsia]] and [[polyuria]] from [[hypokalemia]]-induced [[nephrogenic diabetes insipidus]]. Long-standing [[Hypertension|HTN]] may lead to [[cardiac]], [[retinal]], renal, and [[Neurological disease|neurologic]] problems, with all the associated [[Symptoms and Signs|symptoms and signs]]. Patients with primary hyperaldosteronism may have subclinical [[systolic dysfunction]], more [[bradycardia]], [[Blood pressure|higher blood pressure]] and [[vascular resistance]] values than | Patients with profound [[hypokalemia]] report [[fatigue]], [[muscle weakness]], [[cramping]], [[headaches]], and [[palpitations]]. They can also have [[polydipsia]] and [[polyuria]] from [[hypokalemia]]-induced [[nephrogenic diabetes insipidus]]. Long-standing [[Hypertension|HTN]] may lead to [[cardiac]], [[retinal]], renal, and [[Neurological disease|neurologic]] problems, with all the associated [[Symptoms and Signs|symptoms and signs]]. Patients with primary hyperaldosteronism may have subclinical [[systolic dysfunction]], more [[bradycardia]], [[Blood pressure|higher blood pressure]], and [[vascular resistance]] values than those with the secondary hyperaldosteronism. [[Plasma renin activity]] has been found to be lower in primary than in secondary hyperaldosteronism. | ||
==Common Symptoms== | ===Common Symptoms=== | ||
Common symptoms of primary hyperaldosteronism (PA) include:<ref name="pmid4714286">{{cite journal |vauthors=Rubidge CJ, O'Dowd PB, Powell SJ |title=Difetarsone in the treatment of Trichuris trichiura infections |journal=S. Afr. Med. J. |volume=47 |issue=23 |pages=991–2 |year=1973 |pmid=4714286 |doi= |url=}}</ref><ref name="pmid16932426">{{cite journal |vauthors=Mattsson C, Young WF |title=Primary aldosteronism: diagnostic and treatment strategies |journal=Nat Clin Pract Nephrol |volume=2 |issue=4 |pages=198–208; quiz, 1 p following 230 |year=2006 |pmid=16932426 |doi=10.1038/ncpneph0151 |url=}}</ref><ref name="pmid3216243">{{cite journal |vauthors=Di Tullio M, Alli C, Avanzini F, Bettelli G, Colombo F, Devoto MA, Marchioli R, Mariotti G, Radice M, Taioli E |title=Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA) |journal=J Hypertens Suppl |volume=6 |issue=1 |pages=S87–90 |year=1988 |pmid=3216243 |doi= |url=}}</ref><ref name="pmid21278718">{{cite journal |vauthors=Unwin RJ, Luft FC, Shirley DG |title=Pathophysiology and management of hypokalemia: a clinical perspective |journal=Nat Rev Nephrol |volume=7 |issue=2 |pages=75–84 |year=2011 |pmid=21278718 |doi=10.1038/nrneph.2010.175 |url=}}</ref><ref name="pmid546663">{{cite journal |vauthors=Bautista J, Gil-Neciga E, Gil-Peralta A |title=Hypokalemic periodic paralysis in primary hyperaldosteronism. Subclinical myopathy with atrophy of the type 2A muscle fibers |journal=Eur. Neurol. |volume=18 |issue=6 |pages=415–20 |year=1979 |pmid=546663 |doi= |url=}}</ref><ref name="pmid12908077">{{cite journal |vauthors=Bortolotto LA, Cesena FH, Jatene FB, Silva HB |title=Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma |journal=Arq. Bras. Cardiol. |volume=81 |issue=1 |pages=97–100, 93–6 |year=2003 |pmid=12908077 |doi= |url=}}</ref> | Common symptoms of primary hyperaldosteronism (PA) include:<ref name="pmid4714286">{{cite journal |vauthors=Rubidge CJ, O'Dowd PB, Powell SJ |title=Difetarsone in the treatment of Trichuris trichiura infections |journal=S. Afr. Med. J. |volume=47 |issue=23 |pages=991–2 |year=1973 |pmid=4714286 |doi= |url=}}</ref><ref name="pmid16932426">{{cite journal |vauthors=Mattsson C, Young WF |title=Primary aldosteronism: diagnostic and treatment strategies |journal=Nat Clin Pract Nephrol |volume=2 |issue=4 |pages=198–208; quiz, 1 p following 230 |year=2006 |pmid=16932426 |doi=10.1038/ncpneph0151 |url=}}</ref><ref name="pmid3216243">{{cite journal |vauthors=Di Tullio M, Alli C, Avanzini F, Bettelli G, Colombo F, Devoto MA, Marchioli R, Mariotti G, Radice M, Taioli E |title=Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA) |journal=J Hypertens Suppl |volume=6 |issue=1 |pages=S87–90 |year=1988 |pmid=3216243 |doi= |url=}}</ref><ref name="pmid21278718">{{cite journal |vauthors=Unwin RJ, Luft FC, Shirley DG |title=Pathophysiology and management of hypokalemia: a clinical perspective |journal=Nat Rev Nephrol |volume=7 |issue=2 |pages=75–84 |year=2011 |pmid=21278718 |doi=10.1038/nrneph.2010.175 |url=}}</ref><ref name="pmid546663">{{cite journal |vauthors=Bautista J, Gil-Neciga E, Gil-Peralta A |title=Hypokalemic periodic paralysis in primary hyperaldosteronism. Subclinical myopathy with atrophy of the type 2A muscle fibers |journal=Eur. Neurol. |volume=18 |issue=6 |pages=415–20 |year=1979 |pmid=546663 |doi= |url=}}</ref><ref name="pmid12908077">{{cite journal |vauthors=Bortolotto LA, Cesena FH, Jatene FB, Silva HB |title=Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma |journal=Arq. Bras. Cardiol. |volume=81 |issue=1 |pages=97–100, 93–6 |year=2003 |pmid=12908077 |doi= |url=}}</ref> | ||
=== Hypertension related symptoms === | ==== Hypertension related symptoms ==== | ||
* [[Headache|Headaches]] | * [[Headache|Headaches]] | ||
* [[Facial flushing]] | * [[Facial flushing]] | ||
* [[Weakness]] | * [[Weakness]] | ||
* [[Visual impairment]] | * [[Visual impairment]] | ||
* Impaired consciousness | * [[Loss of consciousness|Impaired consciousness]] | ||
* [[Seizure|Seizures]] ([[hypertensive encephalopathy]]) | * [[Seizure|Seizures]] ([[hypertensive encephalopathy]]) | ||
=== Hypokalemia related symptoms === | ==== Hypokalemia related symptoms ==== | ||
* [[Constipation]] | * [[Constipation]] | ||
* [[Polyuria]] and [[polydipsia]] (because of impaired renal concentrating ability) | * [[Polyuria]] and [[polydipsia]] (because of impaired renal concentrating ability) | ||
* [[Weakness]] | * [[Weakness]] | ||
== Less Common Symptoms == | === Less Common Symptoms === | ||
Less common symptoms of Conn's syndrome (primary hyperaldosteronism) include:<ref name="pmid5596496">{{cite journal |vauthors=Moeller J, Muniz B |title=[Hypokalemic ileus and aldosteronism] |language=German |journal=Med Klin |volume=62 |issue=52 |pages=2019–24 |year=1967 |pmid=5596496 |doi= |url=}}</ref><ref name="pmid15024897">{{cite journal |vauthors=Failor RA, Capell PT |title=Hyperaldosteronism and pheochromocytoma: new tricks and tests |journal=Prim. Care |volume=30 |issue=4 |pages=801–20, viii |year=2003 |pmid=15024897 |doi= |url=}}</ref> | Less common symptoms of Conn's syndrome (primary hyperaldosteronism) include:<ref name="pmid5596496">{{cite journal |vauthors=Moeller J, Muniz B |title=[Hypokalemic ileus and aldosteronism] |language=German |journal=Med Klin |volume=62 |issue=52 |pages=2019–24 |year=1967 |pmid=5596496 |doi= |url=}}</ref><ref name="pmid15024897">{{cite journal |vauthors=Failor RA, Capell PT |title=Hyperaldosteronism and pheochromocytoma: new tricks and tests |journal=Prim. Care |volume=30 |issue=4 |pages=801–20, viii |year=2003 |pmid=15024897 |doi= |url=}}</ref> | ||
* [[Paralysis]] | * [[Paralysis]] | ||
Latest revision as of 17:13, 3 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
The hallmark of primary hyperaldosteronism is resistant hypertension. A positive history of spontaneous or unprovoked hypokalemia and treatment-resistant (refractory) hypertension are suggestive of primary hyperaldosteronism. The most common symptoms of primary hyperaldosteronism include headaches, facial flushing, vision changes, and weakness.
History and Symptoms
Primary hyperaldosteronism may be suspected in the following scenarios:
- Patients with a history of spontaneous or unprovoked hypokalemia along with hypertension.
- Patients who develop severe and/or persistent hypokalemia while on low to moderate doses of potassium-wasting diuretics.
- Patients with a history of treatment-refractory (resistant) hypertension (HTN).
Patients with profound hypokalemia report fatigue, muscle weakness, cramping, headaches, and palpitations. They can also have polydipsia and polyuria from hypokalemia-induced nephrogenic diabetes insipidus. Long-standing HTN may lead to cardiac, retinal, renal, and neurologic problems, with all the associated symptoms and signs. Patients with primary hyperaldosteronism may have subclinical systolic dysfunction, more bradycardia, higher blood pressure, and vascular resistance values than those with the secondary hyperaldosteronism. Plasma renin activity has been found to be lower in primary than in secondary hyperaldosteronism.
Common Symptoms
Common symptoms of primary hyperaldosteronism (PA) include:[1][2][3][4][5][6]
- Headaches
- Facial flushing
- Weakness
- Visual impairment
- Impaired consciousness
- Seizures (hypertensive encephalopathy)
- Constipation
- Polyuria and polydipsia (because of impaired renal concentrating ability)
- Weakness
Less Common Symptoms
Less common symptoms of Conn's syndrome (primary hyperaldosteronism) include:[7][8]
References
- ↑ Rubidge CJ, O'Dowd PB, Powell SJ (1973). "Difetarsone in the treatment of Trichuris trichiura infections". S. Afr. Med. J. 47 (23): 991–2. PMID 4714286.
- ↑ Mattsson C, Young WF (2006). "Primary aldosteronism: diagnostic and treatment strategies". Nat Clin Pract Nephrol. 2 (4): 198–208, quiz, 1 p following 230. doi:10.1038/ncpneph0151. PMID 16932426.
- ↑ Di Tullio M, Alli C, Avanzini F, Bettelli G, Colombo F, Devoto MA, Marchioli R, Mariotti G, Radice M, Taioli E (1988). "Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA)". J Hypertens Suppl. 6 (1): S87–90. PMID 3216243.
- ↑ Unwin RJ, Luft FC, Shirley DG (2011). "Pathophysiology and management of hypokalemia: a clinical perspective". Nat Rev Nephrol. 7 (2): 75–84. doi:10.1038/nrneph.2010.175. PMID 21278718.
- ↑ Bautista J, Gil-Neciga E, Gil-Peralta A (1979). "Hypokalemic periodic paralysis in primary hyperaldosteronism. Subclinical myopathy with atrophy of the type 2A muscle fibers". Eur. Neurol. 18 (6): 415–20. PMID 546663.
- ↑ Bortolotto LA, Cesena FH, Jatene FB, Silva HB (2003). "Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma". Arq. Bras. Cardiol. 81 (1): 97–100, 93–6. PMID 12908077.
- ↑ Moeller J, Muniz B (1967). "[Hypokalemic ileus and aldosteronism]". Med Klin (in German). 62 (52): 2019–24. PMID 5596496.
- ↑ Failor RA, Capell PT (2003). "Hyperaldosteronism and pheochromocytoma: new tricks and tests". Prim. Care. 30 (4): 801–20, viii. PMID 15024897.