Question 1

What is the Meaning of Primary Aldosteronism?

Accepted Answer

Primary Aldosteronism involves adrenal glands autonomously producing excess aldosterone, independent of the renin-angiotensin system. This hormonal surplus leads to increased sodium retention and potassium excretion. The resulting electrolyte imbalance commonly manifests as high blood pressure and often, low blood potassium.

Question 2

What is the Context of Primary Aldosteronism?

Accepted Answer

This disorder affects the adrenal cortex, specifically the zona glomerulosa, where aldosterone synthesis occurs. It disrupts the renin-angiotensin-aldosterone system's normal regulation, crucial for blood pressure and electrolyte balance. Physiological feedback mechanisms are overridden, causing persistent aldosterone secretion despite suppression signals.

Question 3

What is the Significance of Primary Aldosteronism?

Accepted Answer

Identifying primary aldosteronism is clinically important due to its treatable nature and association with heightened cardiovascular morbidity. It causes significant hypertension, often resistant to standard medications. Accurate diagnosis allows targeted therapy, normalizing blood pressure, correcting electrolyte abnormalities, and mitigating risks of stroke, myocardial infarction, and kidney damage.

Question 4

What is the Mechanism of Primary Aldosteronism?

Accepted Answer

Autonomous aldosterone secretion, typically from a benign adrenal adenoma or bilateral adrenal hyperplasia, is the underlying mechanism. Excess aldosterone acts on renal tubules, promoting increased sodium and water reabsorption while enhancing potassium excretion. This leads to extracellular fluid volume expansion, suppressed plasma renin activity, systemic hypertension, and commonly, hypokalemia.

Question 5

What is the Application of Primary Aldosteronism?

Accepted Answer

Clinical evaluation advises screening for resistant hypertension, hypokalemia, or early-onset hypertension family history. The plasma aldosterone-to-renin ratio (ARR) is a primary screening test. Confirmatory tests verify autonomous aldosterone production. Adrenal imaging and selective adrenal venous sampling localize the source, guiding therapy: surgery for unilateral disease or medical management for bilateral conditions.

Question 6

What is the Metric of Primary Aldosteronism?

Accepted Answer

Assessment relies on specific physiological measurements. Plasma aldosterone concentration (PAC) and plasma renin activity (PRA) are fundamental, with their calculated ratio (ARR) being a key screening metric. Serum potassium levels are routinely monitored for hypokalemia. Regular blood pressure readings are essential for evaluating hypertension severity and tracking therapeutic efficacy.

Question 7

What is the Risk of Primary Aldosteronism?

Accepted Answer

Untreated primary aldosteronism carries substantial cardiovascular risks beyond essential hypertension, including higher incidences of stroke, myocardial infarction, and kidney dysfunction. Misdiagnosis or delayed intervention accelerates target organ damage via persistent hypertension and electrolyte imbalances. Surgical adrenalectomy has inherent risks. Long-term pharmacotherapy with mineralocorticoid receptor antagonists may induce side effects like hyperkalemia or gynecomastia.

Primary Aldosteronism

Meaning

Context

Significance

Mechanism

Application

Metric

Risk

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