Adrenal gland and paraganglia
Adrenal hyperfunction / hyperplasia
Hyperaldosteronism

Author: Nat Pernick, M.D. (see Authors page)

Revised: 1 March 2016, last major update February 2013

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PubMed Search: Hyperaldosteronism
Cite this page: Hyperaldosteronism. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/adrenalhyperaldost.html. Accessed December 11th, 2016.
Definition / General
  • Causes urinary loss of potassium and hypokalemia, sodium retention and hypertension
  • Sodium retention causes volume overload, which suppresses the renin-angiotensin system and reduces plasma renin activity; volume overload causes polyuria, polydipsia, nocturia, hypertension, alkalosis and hypernatremia
  • Primary hyperaldosteronism: due to adrenal pathology (most common are adenoma and cortical hyperplasia), idiopathic and rarely carcinoma; also called Conn syndrome
  • Secondary hyperaldosteronism: due to increased levels of plasma renin from non-adrenal pathology, including congestive heart failure, pregnancy (due to estrogen), decreased renal perfusion (renal arterial stenosis, nephrosclerosis), hypoalbuminemia, ovarian tumor and hyperthyroidism
  • Tertiary hyperaldosteronism (Bartter syndrome): hypertrophy and hyperplasia of renal juxtaglomerular cells, causing elevated plasma renin, angiotensin II and aldosterone, hypokalemic alkalosis but no hypertension; some cases are autosomal recessive; glucocorticoid suppressible hyperaldosteronism - infants or adults, rare and familial; due to mutation which causes developmental derangement of cortical zonation, with hybrid cells between glomerulosa and fasciculata that are under the influence of ACTH, but can be suppressed by dexamethasone
  • Symptoms: hypokalemia causes weakness, paresthesias, visual disturbances and tetany
  • Diagnosis: non-suppressible aldosterone excretion with normal cortisol excretion, low plasma renin
Treatment
  • Surgery for adenoma
  • Surgery usually not curative for bilateral adrenal hyperplasia - these patients need spironolactone or other antihypertensive drugs
Gross Description
  • Adenomas are small, unilateral, solitary and golden-yellow
Micro Description
  • Thickened glomerulosa layer with tongue-like projections into fasciculata
  • Spironolactone bodies in patients treated with spironolactone
  • Variable micronodules of clear cells
  • Note: adenomas are usually one nodule; nodular hyperplasia is usually bilateral