E26.0
DESCRIPTION
Increased aldosterone production usually due to an adrenal adenoma (Conn's syndrome) or idiopathic bilateral adrenal hyperplasia (the majority of cases).
Clinical
Suspect in a patient with resistant hypertension or hypertension with hypokalaemia.
Diagnosis
Elevated serum aldosterone with a suppressed renin level and elevated aldosterone/renin ratio.
ACE-inhibitors, angiotensin receptor blockers (ARBs), and diuretics can give falsely elevated or lowered results. Stop all these drugs for a minimum of 2 weeks before testing. Stop spironolactone for 6 weeks before testing.
Because of limited specificity, a positive screening test result should be followed by a confirmatory test. A negative random ratio test does not necessarily exclude the diagnosis.
MEDICINE TREATMENT
Adrenal adenoma
A surgical resection/removal of adenoma.
Bilateral hyperplasia
Standard anti-hypertensive therapy, including spironolactone.
- Spironolactone, oral, 100–200 mg daily.
REFERRAL
All patients to an endocrinologist or a hypertension centre for confirmation of the diagnosis and further treatment.