Hyperaldosteronism - NYSORA

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Contributors

Hyperaldosteronism

Hyperaldosteronism

Learning objectives

  • Describe hyperaldosteronism
  • Recognize the symptoms and signs of hyperaldosteronism
  • Anesthetic management of a patient with hyperaldosteronism

Definition and mechanisms

  • Hyperaldosteronism is a condition in which one or both adrenal glands produce too much aldosterone 
  • Aldosterone regulates blood pressure by controlling blood levels of potassium and sodium

Classification

  • Primary hyperaldosteronism (Conn’s syndrome): Overproduction of aldosterone independent from the renin-angiotensin-aldosterone system (RAAS), usually caused by a tumor of the adrenal gland
  • Secondary hyperaldosteronism (hyperreninism): Overproduction of aldosterone due to overactivity of the RAAS

Signs and symptoms

Complications

The most common complications are caused by hypertension

Pathophysiology

hyperaldosteronism, Conn's syndrome, aldosterone, hypertension, hypernatremia, hypokalemia, metabolic alkalosis, polyuria

Treatment

Primary hyperaldosteronism

  • Surgery to remove the adrenal gland tumor
  • Potassium-sparing diuretics that act as aldosterone antagonists (i.e., spironolactone, eplerenone, and amiloride)
  • Limit salt intake

Secondary hyperaldosteronism

  • No surgery
  • Potassium-sparing diuretics that act as aldosterone antagonists (i.e., spironolactone, eplerenone, and amiloride)
  • COX-2 inhibitors 
  • Limit salt intake

Management

Hyperaldosteronism, Conn syndrome, preoperative, intraoperative, management, spironolactone, potassium, hypokalemia, antihypertensive drugs, sedation, fluid volume status evaluation, hypovolemia, heart rate, blood pressure, hematocrit, hyperventilation, respiratory alkalosis, sevoflurane, acid-base, cortisol, hydrocortisone, etomidate

Keep in mind

  • The anesthesiologist must deal with hypertension, hypovolemia, hypokalemia, and cortisol supplementation (depending case by case) in patients with hyperaldosteronism

Suggested reading

  • Domi R, Sula H, Kaci M, Paparisto S, Bodeci A, Xhemali A. Anesthetic considerations on adrenal gland surgery. J Clin Med Res. 2015;7(1):1-7.
  • Jano A, Domi R, Berdica L, et al. Anaesthetic considerations of Conn syndrome: a case presentation and mini-review the anaesthesiologist and Conn syndrome. Clin Med Res 2014;3(5):132–135. 
  • Davies M, Hardman J. Anaesthesia and adrenocortical disease. Continuing Education in Anaesthesia, Critical Care & Pain. 2005;5(4):122–126.

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