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Internal Medicine
Surgery is successful in 50%-95% of cases and is followed by normal
pituitary and adrenal function as well as cure of Cushing’s diseases.
A. Hyperaldosteronism
Aldosteronism: is a syndrome associated with hypersecretion of the mineralocorticoid,
1. Primary aldosteronism: the cause of excess aldosterone production resides with in the
adrenal gland
Aldosterone producing adrenal adenoma (Conn’s
syndrome): in most cases ,
unilateral small adenoma which can occur on either side
Adrenal carcinoma: rare cause of aldosteronism
Bilateral cortical nodular hyperplasia /idiopathic hyperaldosteronism
2. Secondary aldosteronism: the stimulus for excess aldosterone production is outside the
adrenal gland. It refers to a appropriately increased production of aldosterone in response to
activation of the renin-angiotensin system
Accelerated phase of hypertension
Congestive heart failure
Other edema states : nephritic syndrome , CLD etc
Pathophysiology: The excess aldosterone increase the reabsorption of sodium and excretion
of potassium and hydrogen ions, in the distal renal tubules, which results progressive depletion
of potassium and leads to hypokalemia.
Signs and symptoms:
Moat patients have diastolic hypertension resulting from sodium retention. Patients
may complain headache and symptoms of other organ damage
Hypokalemia and associated symptoms: muscle weakness and fatigue.
Impairment of urinary concentrating abilityÆpolyuria and polydipsia.
Metabolic alkalosis with paresthesia, possibly tetany
Evidences of left ventricular enlargement
ECG signs of hypokalemia : prominent U waves and cardiac arrhythmias