Adrenal gland & paraganglia
Adrenal hyperfunction / hyperplasia
Hyperaldosteronism
Author: Nat Pernick, M.D.
Last author update: 1 February 2013
Last staff update: 4 June 2019
Copyright: 2003-2019, PathologyOutlines.com, Inc.
PubMed Search: Hyperaldosteronism
Table of Contents
Definition / general | Treatment | Gross description | Microscopic (histologic) descriptionCite this page: Pernick N. Hyperaldosteronism. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalhyperaldost.html. Accessed December 25th, 2024.
Definition / general
- Causes urinary loss of potassium and hypokalemia, sodium retention and hypertension
- Sodium retention causes volume overload, which suppresses the renin-angiotensin system and reduces plasma renin activity; volume overload causes polyuria, polydipsia, nocturia, hypertension, alkalosis and hypernatremia
- Primary hyperaldosteronism: due to adrenal pathology (most common are adenoma and cortical hyperplasia), idiopathic and rarely carcinoma; also called Conn syndrome
- Secondary hyperaldosteronism: due to increased levels of plasma renin from non-adrenal pathology, including congestive heart failure, pregnancy (due to estrogen), decreased renal perfusion (renal arterial stenosis, nephrosclerosis), hypoalbuminemia, ovarian tumor and hyperthyroidism
- Tertiary hyperaldosteronism (Bartter syndrome): hypertrophy and hyperplasia of renal juxtaglomerular cells, causing elevated plasma renin, angiotensin II and aldosterone, hypokalemic alkalosis but no hypertension; some cases are autosomal recessive; glucocorticoid suppressible hyperaldosteronism - infants or adults, rare and familial; due to mutation which causes developmental derangement of cortical zonation, with hybrid cells between glomerulosa and fasciculata that are under the influence of ACTH, but can be suppressed by dexamethasone
- Symptoms: hypokalemia causes weakness, paresthesias, visual disturbances and tetany
- Diagnosis: non-suppressible aldosterone excretion with normal cortisol excretion, low plasma renin
Treatment
- Surgery for adenoma
- Surgery usually not curative for bilateral adrenal hyperplasia - these patients need spironolactone or other antihypertensive drugs
Gross description
- Adenomas are small, unilateral, solitary and golden-yellow
Microscopic (histologic) description
- Thickened glomerulosa layer with tongue-like projections into fasciculata
- Spironolactone bodies in patients treated with spironolactone
- Variable micronodules of clear cells
- Note: adenomas are usually one nodule; nodular hyperplasia is usually bilateral
