Primary
Primary aldosteronism (hyporeninemic hyperaldosteronism) was previously thought to be most commonly caused by an adrenal adenoma, termed Conns syndrome. However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is the cause in up to 70% of cases. Differentiating between the two is important, as this determines treatment. Also, see congenital adrenal hyperplasia. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism.Two familial forms have been identified: type I (dexamethasone suppressible), and type II, which has been linked to the 7p22 gene.Features

Hypertension
Hypokalemia (e.g., may cause muscle weakness)
AlkalosisInvestigations

High serum aldosterone
Low serum renin
High-resolution CT abdomenManagement

Adrenal adenoma: surgery
Bilateral adrenocortical hyperplasia: aldosterone antagonist, e.g., spironolactone

Secondary
Secondary hyperaldosteronism (also hyperreninism, or hyperreninemic hyperaldosteronism) is due to overactivity of the renin–angiotensin–aldosterone system (RAAS).Secondary refers to an abnormality that indirectly results in pathology through a predictable physiologic pathway, i.e., a renin-producing tumor leads to increased aldosterone, as the bodys aldosterone production is normally regulated by renin levels. One cause is a juxtaglomerular cell tumor. Another is renal artery stenosis, in which the reduced blood supply across the juxtaglomerular apparatus stimulates the production of renin. Likewise, fibromuscular dysplasia may cause stenosis of the renal artery, and therefore secondary hyperaldosteronism. Other causes can come from the tubules: low reabsorption of sodium (as seen in Bartter and Gitelman syndromes) will lead to hypovolemia/hypotension, which will activate the renin–angiotensin system (RAAS).Secondary hyperaldosteronism can also be caused by excessive ingestion of licorice or other members of the Glycyrrhiza genus of plants that contain the triterpenoid saponin glycoside known as glycyrrhizin.
Gastrocutaneous syndrome is a rare autosomal dominant cutaneous condition characterized by multiple lentigines. See also
Gardners syndrome
List of cutaneous conditions

References


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