Hyperaldosteronism refers to excessive levels of aldosterone
Aldosterone is a major mineralocorticoid hormone produced by the adrenal gland, in the zona glomerulosa, which is the outermost layer of the adrenal cortex. Aldosterone plays an important role in the regulation of sodium and water in the body, thereby maintaining and having effect on blood pressure.
It is a type under ALDOSTERONISM, so therefore, lets start from the very beginning.
ALDOSTERONISM/ CONN’S SYNDROME
There are disorders of the aldosterone secretion and are divided into two;
- Primary hyperaldosteronism
- Secondary hyperaldosteronism
Primary Hyperaldosteronism
This condition is caused by excess aldosterone production leading to sodium retention, potassium loss and the combination of hypokalemia and hypertension
Causes of hyperaldosteronism
- Adrenal adenomas (Conn’s syndrome) which accounts for 60% cases of primary
hyperaldosteronsin
Clinical presentation
> Hypertension
> Hypokalemia (<3.5mmol/l
> Muscle weakness
> Nocturia
> Tetany (involuntary muscle contractions)
Diagnosis
- High sodium
- Low potassium level
- High serum aldosterone level
- Low renin level
- Aldosterone excretion rate after salt loading is diagnostic for primary aldosteronism
- Renin-aldosterone stimulation test
Treatment and management of primary hyperaldosteronism.
- Removal of adenoma surgically (adrenalectomy)
- Those with hypokaleamia should be treated by aldosterone antagonists e.g. spironolactone (100–400mg) daily.
- Pair with aldosterone receptor antagonist e.g. eplerenone is a useful alternative.
- Calcium channel blockers like Nefidipine are also useful moderately
- Correct hypokalemia
- Usual postoperative care with abdominal surgery
- Administer steroids like;
– Hydrocortisone–Cortisol
– Cortisone–Cortate
– Prednisone–Deltasone
– Prednisolone-Prelone
– Triamcinolone–Kenalog
– Betamethasone–Celestone
– Fludrocortisone (contains both mineralocorticoid and Florinef glucocorticoid) - Fluids
- Monitoring of blood sugar
- Control of hypertension with spironolactone
- Aldosterone-blocking drugs – medications that can stop the production of aldosterone can be used to treat hyperaldosteronism. These are also the treatment of choice in individuals who are not fit to have surgical removal of the adrenal gland with the tumor. In other cases, hyperaldosteronism is caused by the overactivity of both adrenal glands. Surgery will not be an option since partial removal of the glands will not control hypertension and other symptoms of the disease. Complete removal of the glands can cause Addison’s disease and will require the person with hyperaldosteronism to take corticosteroids for life. Therefore, the use of aldosterone-blocking medication may only be the only option to treat the condition.
Secondary hyperaldosteronism
This causes the clinical syndrome of the primary hyperaldosteronism, it arises when there is excess rennin (hence Angiotensin II) stimulation of the zonaglomerulosa
Common causes are accelerated hypertension and renal arterial stenosis.
Causes associated with norm tension include congestive cardia failure Cirrhosis
Treatment include
- Angiotensin–converting enzyme inhibitors e.g. captopril, enalapril and angiotensin II antagonists e.g. losartan, are effective in heart failure, both symptomatically and increasing the lifespan and spironolactone too has been found to increase the survival of heart failure patient.
Complications
- Problems related to high blood pressure – persistent or prolonged high blood pressure can lead to the following:
Heart attack, heart failure, and other heart problems - Stroke
- Kidney disease or kidney failure
- Problems related to hypokalemia or low blood potassium level
- Arrythmias
- Muscle cramps
- Excessive thirst and urination
Hyperaldosteronism Nursing Diagnosis
Diagnosis 1: Decreased cardiac output related to increased vascular resistance due to hypertension, as evidenced by high blood pressure level of 170/89, shortness of breath, high aldosterone levels, fatigue and inability to do activities of daily living as normal.
Desired Outcome: The patient will be able to maintain adequate cardiac output.
Intervention: Assess the patient’s vital signs and characteristics of heart beat 4 hourly. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.
Administer prescribed medications for hypertension and hyperaldosteronism.
Rational: To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
The category or type of drugs depend on the average blood pressure reading, underlying conditions, and complications. These include vasodilators (direct or indirect), diuretics, and cardiac workload reducers. The use of aldosterone-blocking drugs can also be used as a treatment option for individuals with hyperaldosteronism caused by overactivity of both adrenal glands.
Diagnosis 2: Electrolyte Imbalance related to hypokalemia as evidenced by serum potassium level of 2.9 mmol/L, high aldosterone levels, polyuria, increased thirst, weakness, tachycardia, and fatigue
Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
Intervention: Obtain daily blood sample from the patient.
Administer a slow intravenous potassium solution as prescribed
Rationale: Biochemistry is needed to check for the level of serum potassium
A slow intravenous potassium solution is given to raise the potassium level in the blood stream. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site.
