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Metabolic acidosis
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Hyperkalemia
Hyperglycemia
Metabolic alkalosis
High renin levels
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This patient has primary hyperaldosteronism, which causes increased urinary hydrogen ion secretion and subsequent metabolic alkalosis. In primary hyperaldosteronism, there is excessive production of aldosterone by the adrenal glands independent of proper regulation from the renin-angiotensin-aldosterone system. Excessive production of mineralocorticoids leads to increased activity of the Na+/K+ channels in the collecting tubules and sodium retention (causing hypertension) as well as potassium loss (causing hypokalemia). Furthermore, increased aldosterone also results in increased hydrogen ion secretion leading to metabolic alkalosis. Causes of primary hyperaldosterone include adrenal adenomas (Conn's syndrome), adrenal hyperplasia, and adrenal carcinomas. Symptoms include hypertension, headache, weakness, polydipsia, and polyuria. Diagnosis may be made through the plasma aldosterone to renin ratio or 24 hour urine aldosterone. CT or MRI of the adrenals may reveal an adenoma which should be removed if found. Chao et al. discuss the diagnosis and management of primary aldosteronism. Primary aldosteronism is the most common secondary form of arterial hypertension with a high prevalence amoung patients with resistant hypertension. Aldosterone has been found to cause cardiovascular activity. Adrenal imaging is often inaccurate for differentiation between an adenoma and hyperplasia, and adrenal venous sampling is essential for selecting the appropriate treatment modality. Viera and Neutz discuss the diagnosis of secondary hypertension in an age-based approach. Secondary hypertension may be suggested by flushing and sweating (indicative of a pheochromocytoma), a renal bruit (suggestive of renal artery stenosis), or laboratory abnormalities such as hypokalemia (suggestive of aldosteronism). In young adults, particularly women, who present with hypertension, one should consider secondary hypertension as a possible cause. Illustration A depicts an adrenal adenoma on CT in multiple cuts. Incorrect Answers: Answers 1, 2, and 5: Metabolic acidosis, hyperkalemia, and high renin levels would be present not be expected in hyperaldosteronism as explained above. Answer 3: Hyperglycemia is not found in hyperaldosteronism.
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