Hyperaldosteronism - Revision history

Cole Ettingoff: /* External Links */

2025-05-05T23:50:26Z

External Links

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	==External Links==		==External Links==
			[https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15026 American Heart Association – Secondary Hypertension Guidelines]

			[https://www.ncbi.nlm.nih.gov/books/NBK539779/ NIH – Primary Aldosteronism Overview]

	==References==		==References==
	<references/>		<references/>

2025-05-05T23:48:43Z

Background

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	* Secondary hyperaldosteronism – due to increased renin from conditions like renal artery stenosis, heart failure, or cirrhosis.		* Secondary hyperaldosteronism – due to increased renin from conditions like renal artery stenosis, heart failure, or cirrhosis.

	Primary hyperaldosteronism is an important and potentially reversible cause of secondary hypertension, accounting for 5–10% of hypertensive cases and up to 20% of treatment-resistant hypertension. It is often underdiagnosed in emergency settings.		Primary hyperaldosteronism is an important and potentially reversible cause of secondary hypertension, accounting for 5–10% of hypertensive cases and up to 20% of treatment-resistant hypertension. It is often underdiagnosed in emergency settings. <ref> Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–1916. doi:10.1210/jc.2015-4061 </ref>

	==Clinical Features==		==Clinical Features==

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Workup

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	* Metabolic alkalosis		* Metabolic alkalosis

	Recommended ED labs:		Recommended ED labs: <ref> Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607–618. doi:10.1111/j.1365-2265.2007.02775.x </ref>

	* Electrolytes (noting hypokalemia and alkalosis)		* Electrolytes (noting hypokalemia and alkalosis)

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2025-05-05T23:45:48Z

Disposition

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	==Disposition==		==Disposition==
			Admit if:

			* Hypertensive emergency or end-organ damage
			*
			* Life-threatening hypokalemia or arrhythmia
			*
			* Severe electrolyte derangements

			Discharge with outpatient follow-up if:

			* Mild symptoms, stable vitals
			*
			* Newly discovered hypokalemia with controlled BP
			*
			* Reliable follow-up for endocrine evaluation

	==See Also==		==See Also==

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Management

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	==Management==		==Management==
			In the Emergency Department:
			* Correct hypokalemia (PO or IV potassium)
			*
			* Avoid ACE inhibitors/ARBs until potassium is corrected
			*
			* Manage hypertension per usual protocols (IV meds if emergent)
			*
			* Initiate cardiac monitoring if K⁺ <3.0 mEq/L or if arrhythmia is present

	==Disposition==		==Disposition==

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Diagnosis

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	===Diagnosis===		===Diagnosis===
			Clinical suspicion in setting of hypertension + hypokalemia

			Confirmatory outpatient testing with PAC/PRA ratio

			Further endocrinology-guided evaluation determines surgical vs. medical management

	==Management==		==Management==

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Workup

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 ==Evaluation==
 ===Workup===
 ===Diagnosis===

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Differential Diagnosis

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 ==Differential Diagnosis==
+* Essential hypertension
 ==Evaluation==

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Clinical Features

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 ==Clinical Features==
+* Hypertension (often severe or resistant)
 ==Differential Diagnosis==

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	==See Also==		==See Also==
			[[Hypokalemia]]

			[[Hypertensive emergency\|Hypertensive Emergency]]

			[[Pheochromocytoma]]

			[[Hypertension (main)\|Renovascular Hypertension]]

			[[Cushing's syndrome\|Cushing’s Syndrome]]

	==External Links==		==External Links==