

What is Aldosterone?
 DEFINITION

Aldosterone is produced in the cortex of
the adrenal glands, which are located
above the kidneys.
Aldosterone regulates the balance of
water and electrolytes in the body,
encouraging the kidney to excrete
potassium into the urine and retain
sodium, thereby retaining water. It is
classified as a mineralocorticoid hormone.
 FUNCTION

 Aldosterone affects the body's ability to regulate
blood pressure. It sends the signal to organs, like the
kidney and colon, that can increase the amount of
sodium the body sends into the bloodstream or the
amount of potassium released in the urine. The
hormone also causes the bloodstream to re-absorb
water with the sodium to increase blood volume. All
of these actions are integral to increasing and
lowering blood vessels. Indirectly, the hormone also
helps maintain the blood's pH and electrolyte levels.


 FUNCTION

 Aldosterone is closely linked to two other hormones:
renin and angiotensin, which create the renin-
angiotensin-aldosterone system. This system is activated
when the body experiences a decrease in blood flow to
the kidneys, such as after a drop in blood pressure, or a
significant drop in blood volume after a hemorrhage or
serious injury. Renin is responsible for the production of
angiotensin, which then causes the release of aldosterone.
Once the body is rehydrated and has proper salt levels in
the blood, renin levels fall, and aldosterone levels lower
as a result.
 DEFINITION

Primary aldosteronism, also known
as primary
hyperaldosteronism or Conn's
syndrome, is excess production of
the hormone aldosterone by the adrenal
glands resulting in low renin levels.
 DEFINITION

Primary aldosteronism is
aldosteronism caused by autonomous
production of aldosterone by the
adrenal cortex (due to hyperplasia,
adenoma, or carcinoma).
 DEFINITION

In primary aldosteronism, your adrenal
glands produce too much aldosterone,
causing you to lose potassium and
retain sodium. The excess sodium in
turn holds on to water, increasing your
blood volume and blood pressure.
 CLINICAL MANIFESTATION

The main signs of primary
aldosteronism are:
 Moderate to severe high
blood pressure
 High blood pressure that
takes several medications
to control (resistant
hypertension)
 High blood pressure
along with a low
potassium level
(hypokalemia)
 CLINICAL MANIFESTATION

 People often have few or no symptoms. They may get
occasional muscular weakness, muscle spasms, tingling
sensations, or excessive urination.
 High blood pressure, manifestations of muscle cramps
(due to hyper excitability of neurons secondary to low
blood calcium), muscle weakness (due to hypo
excitability of skeletal muscles secondary to
hypokalemia), and headaches (due to low blood
potassium or high blood pressure) may be seen.
 Secondary hyperaldosteronism is often related to
decreased cardiac output which is associated with
elevated renin levels.
 CAUSES

Common conditions causing the overproduction of
aldosterone include:
 A benign growth in an adrenal gland (aldosterone-
producing adenoma) — a condition also known as
Conn's syndrome
 Overactivity of both adrenal glands (idiopathic
hyperaldosteronism)
 CAUSES

In rare cases, primary aldosteronism may be caused by:
 A cancerous (malignant) growth of the outer layer
(cortex) of the adrenal gland (adrenal cortical
carcinoma)
 A rare type of primary aldosteronism called
glucocorticoid-remediable aldosteronism that runs in
families and causes high blood pressure in children
and young adults
 COMPLICATIONS

Primary aldosteronism can lead to high
blood pressure and low potassium
levels. These complications in turn can
lead to other problems.
 COMPLICATIONS

Problems related to high blood pressure
 Persistently elevated blood pressure can lead to
problems with your heart and kidneys, including:
 Heart attack
 Heart failure
 Left ventricular hypertrophy — enlargement of the
muscle that makes up the wall of the left ventricle,
one of your heart's pumping chambers
 Stroke
 Kidney disease or kidney failure
 Premature death
 COMPLICATIONS

Problems related to low potassium levels
Some, but not all, people with primary aldosteronism
have low potassium levels (hypokalemia). Mild
hypokalemia may not cause any symptoms, but very
low levels of potassium can lead to:
 Weakness
 Cardiac arrhythmias
 Muscle cramps
 Excess thirst or urination
 PATHOPHYSIOLOGY

 The most important factors that predict the
pathophysiologic association of hypokalemia with
primary aldosteronism are aldosterone hypersecretion,
which acts on the cortical collecting duct to stimulate
potassium secretion into the tubular fluid, thus enhancing
renal/urinary potassium wasting; adequate intravascular
volume, which enables adequate water delivery (tubular
flow rate) to the renal distal convoluted tubules (DCTs)
and collecting ducts to enable renal potassium loss; and
adequate dietary sodium intake, which, in turn, increases
total body potassium, renal/ tubular sodium delivery,
and, thus, enhances renal potassium loss via the
countercurrent transport system

 DIAGNOSIS

Screening test
Initially, your doctor is likely to measure the
levels of aldosterone and renin in your blood.
Renin is an enzyme released by your kidneys
that helps regulate blood pressure. The
combination of a very low renin level with a
high aldosterone level suggests that primary
aldosteronism may be the cause of your high
blood pressure.
 DIAGNOSIS
Confirmation tests

If the aldosterone-renin test suggests that you might have
primary aldosteronism, you'll need another test to confirm
the diagnosis, such as one of the following:
 Oral salt loading. You'll follow a high-sodium diet for
three days before your doctor measures aldosterone and
sodium levels in your urine.
 Saline infusion test. Your aldosterone levels are tested
after sodium mixed with water (saline) is infused into
your bloodstream for several hours.
 Fludrocortisone suppression test. After you've followed
a high-sodium diet and taken fludrocortisone — which
mimics the action of aldosterone — for several days,
aldosterone levels in your blood are measured.
 DIAGNOSIS
Additional tests

If you receive a diagnosis of primary aldosteronism, your
doctor will run additional tests to determine whether the
underlying cause is an aldosterone-producing adenoma or
overactivity of both adrenal glands. Tests may include:
 Abdominal computerized tomography (CT) scan. A
CT scan can help identify a tumor on your adrenal
gland or an enlargement that suggests overactivity.
You may still need additional testing after a CT scan
because this imaging test may miss small but
important abnormalities or find tumors that don't
produce aldosterone.
 DIAGNOSIS

 Adrenal vein sampling. A radiologist draws blood
from both your right and left adrenal veins and
compares the two samples. Aldosterone levels that
are significantly higher on one side indicate the
presence of an aldosteronoma on that side. Similar
aldosterone levels on both sides point to overactivity
in both glands.
 This test involves placing a tube in a vein in your
groin and threading it up to the adrenal veins.
Though essential for determining the appropriate
treatment, this test carries the risk of bleeding or a
blood clot in the vein.
 NURSING INTERVENTION

 Monitor vital signs, I&O, daily weights.
 Maintain sodium restriction as ordered.
 Administer spironolactone (Aldactone) and potassium
supplements as ordered.
 Prepare the client for an adrenelectomy if indicated.
 Provide client teaching and discharge planning
concerning Use and side effects of medication if the client
is being maintained on spironolactone therapy.
 Signs of symptoms of hypo/ hyperaldosteronism needs
for frequent blood pressure checks and follow-up care
 NURSING INTERVENTION

 Administer or teach self-administration of anti-hypertensives as
ordered.
 Assess for dependent edema; encourage activity, frequent
repositioning, and elevation of feet periodically to reduce
edema.
 Perform usual postoperative care for abdominal surgery,
including frequent check of vital signs, assessing for
hemorrhage, turning, coughing and deep breathing, early
ambulation, slow progression of diet when bowel sounds
return, and control of pain with schedule opioid administration
or patient-controlled analgesia.
 Maintain non stressful environment, promote rest, and provide
meticulous care to protect patient against infection and other
complications that could cause adrenal crisis
 Patient Teaching

 Instruct the patient regarding the nature of illness, the
necessary treatment, and the need for continued medical care.
 Instruct the patient on the importance of following prescribed
medical treatments. The patient must remain on spironolactone
for life. Advise on reporting significant adverse effects and if
drug interferes with sexual performance and quality of life.
 Advice the patient that glucocorticoid administration may be
temporary (after subtotal or unilateral adrenalectomy) or long
term (for bilateral adrenalectomy); dose may need to be
increase during times of illness or stress.
 Teach the patient and family members how to take blood
pressure readings, if indicated.
 TREATMENT

Treatment for primary aldosteronism
depends on the underlying cause, but its
basic goal is to normalize or block the effect
of high aldosterone levels and prevent the
potential complications of high blood
pressure and low potassium levels.
 TREATMENT

Treatment for an adrenal gland tumor
An adrenal gland tumor may be treated with surgery or
medications and lifestyle changes.
 Surgical removal of the gland. Surgical removal of the
adrenal gland containing the tumor (adrenalectomy) is
usually recommended because it may permanently
resolve high blood pressure and potassium deficiency,
and it can bring aldosterone levels back to normal. Blood
pressure usually drops gradually after a unilateral
adrenalectomy. Your doctor will follow you closely after
surgery and progressively adjust or eliminate your high
blood pressure medications.
 TREATMENT

Aldosterone-blocking drugs. If you're
unable to have surgery or prefer not to,
primary aldosteronism caused by a benign
tumor can also be treated with aldosterone-
blocking drugs (mineralocorticoid receptor
antagonists) and lifestyle changes. But high
blood pressure and low potassium will
return if you stop taking your medications.
 TREATMENT

A combination of medications and lifestyle modifications can
effectively treat primary aldosteronism caused by
overactivity of both adrenal glands (bilateral adrenal
hyperplasia).
 Medications. Mineralocorticoid receptor antagonists
block the action of aldosterone in your body. Your doctor
may first prescribe spironolactone. This medication helps
correct high blood pressure and low potassium, but it
may cause problems.
 In addition to blocking aldosterone receptors,
spironolactone blocks androgen and progesterone
receptors and may inhibit the action of these hormones.
Side effects can include male breast enlargement
(gynecomastia), decreased sexual desire, impotence,
menstrual irregularities and gastrointestinal distress.
 TREATMENT

Lifestyle changes. High blood pressure
medications are more effective when
combined with a healthy diet and lifestyle.
Work with your doctor to create a plan to
reduce the sodium in your diet and maintain
a healthy body weight. Getting regular
exercise, limiting the amount of alcohol you
drink and stopping smoking also may
improve your response to medications.