Hyperaldosteronism

Learning objectives

• Describe hyperaldosteronism
• Recognize the symptoms and signs of hyperaldosteronism
• Anesthetic management of a patient with hyperaldosteronism

Definition and mechanisms

• Hyperaldosteronism is a condition in which one or both adrenal glands produce too much aldosterone 
• Aldosterone regulates blood pressure by controlling blood levels of potassium and sodium

Classification

• Primary hyperaldosteronism (Conn’s syndrome): Overproduction of aldosterone independent from the renin-angiotensin-aldosterone system (RAAS), usually caused by a tumor of the adrenal gland
• Secondary hyperaldosteronism (hyperreninism): Overproduction of aldosterone due to overactivity of the RAAS

Signs and symptoms

• Hypertension
  • Headache
  • Dizziness
  • Vision changes
  • Difficulty breathing
• Fluid and electrolyte imbalances
  • Hypokalemia
    • Muscle weakness
    • Muscle spasm
    • Tingling and numbness
    • Fatigue
    • Polydipsia
    • Polyuria
  • Hypernatremia
  • Hypermagnesemia 
  • Metabolic alkalosis
  • Volume depletion

Complications

The most common complications are caused by hypertension

• Atrial fibrillation
• Left ventricular hypertrophy
• Heart attack
• Stroke

Pathophysiology

Treatment

Primary hyperaldosteronism

• Surgery to remove the adrenal gland tumor
• Potassium-sparing diuretics that act as aldosterone antagonists (i.e., spironolactone, eplerenone, and amiloride)
• Limit salt intake

Secondary hyperaldosteronism

• No surgery
• Potassium-sparing diuretics that act as aldosterone antagonists (i.e., spironolactone, eplerenone, and amiloride)
• COX-2 inhibitors 
• Limit salt intake

Management

Keep in mind

• The anesthesiologist must deal with hypertension, hypovolemia, hypokalemia, and cortisol supplementation (depending case by case) in patients with hyperaldosteronism

Suggested reading

• Domi R, Sula H, Kaci M, Paparisto S, Bodeci A, Xhemali A. Anesthetic considerations on adrenal gland surgery. J Clin Med Res. 2015;7(1):1-7.
• Jano A, Domi R, Berdica L, et al. Anaesthetic considerations of Conn syndrome: a case presentation and mini-review the anaesthesiologist and Conn syndrome. Clin Med Res 2014;3(5):132–135. 
• Davies M, Hardman J. Anaesthesia and adrenocortical disease. Continuing Education in Anaesthesia, Critical Care & Pain. 2005;5(4):122–126.

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