ALDOSTERONISM

Prepared by: Roxanne Mae E. Birador S.N.

LAYERS OF ADRENAL CORTEX

ALDOSTERONE Conserve sodium in the body. It promotes reabsorption of sodium and elimination of potassium.

ALDOSTERONISM excessive secretion of aldosterone

OVERVIEW

CAUSES (Hyporeninemic Hyperaldosteronism)

Over activity of both adrenal glands

A malignant growth of the outer layer (cortex) of the adrenal gland (adrenal cortical cancer)

(A) Aldosterone producing adenoma; (B) Micronodular diffuse hyperplasia.

Excessive thirst (polydipsia)Increased urination (polyuria)Hypokalemia Hypernatremia Muscle weaknessFatigueHypertension

CLINICAL MANIFESTATION

• PAC:PRA ratio

The first test used in patients suspected to have primary hyperaldosteronism measures the Plasma Aldosterone Concentration (PAC) to Plasma Renin Activity (PRA) Ratio.

A high ratio of PAC to PRA suggests primary hyperaldosteronism.

SCREENING TESTS

Captopril Suppression Test

Captopril is a medication for high blood pressure. A patient is given a single dose of captopril, after which the levels of aldosterone and renin in the blood are measured.

In patients with primary hyperaldosteronism, the level of aldosterone in the blood is still high and the level of renin is low even after captopril administration.

CONFIRMATION TESTS

24-Hour Urinary Excretion of Aldosterone Test

In the 24-hour urinary excretion of aldosterone test, a patient eats a high-salt diet for 5 days before measuring the amount of aldosterone in the urine over a 24-hour period.

In patients with primary hyperaldosteronism, aldosterone will not be suppressed by the salt load, and the level of aldosterone in the urine will be high.

Saline Suppression Test:

In the saline suppression test, the patient is given a salt solution through an IV, after which the levels of aldosterone and renin in the blood are measured.

In patients with primary hyperaldosteronism, the level of aldosterone in the blood is still high and the level of renin is low even after this salt loading.

CT scan showing right adrenal adenoma

ABDOMINAL CT SCAN

Aldosterone-blocking drugs (mineralocorticoid receptor antagonists): DIURETICS

Eplerenone (Inspra)Spironolactone (Aldactone)

MEDICATIONS

• Give daily doses early so that increased urination does not interfere with sleep.

• Measure and record regular weight to monitor mobilization of edema fluid.

• Avoid giving food rich in potassium.• Review electrolyte levels.

NURSING RESPONSIBILITIES

Amlodipine (Norvasc)Diltiazem (Cardizem, Tiazac)FelodipineIsradipineNicardipine (Cardene SR)Nifedipine (Procardia)Nisoldipine (Sular)Verapamil (Calan, Verelan)

CALCIUM CHANNEL BLOCKERS

• Take medication with food or milk.

• Alcohol should be avoided.

NURSING RESPONSIBILITIES

Accupril (quinapril)Aceon (perindopril)Altace (ramipril)Capoten (captopril)Lotensin (benazepril)Mavik (trandolapril)Monopril (fosinopril)Prinivil, Zestril (lisinopril)

ACE INHIBITORS

• Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. 

• The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing.

NURSING RESPONSIBILITIES

Example: K-Lyte

• Take this medication with food or just after a meal.

• Avoid lying down for at least 30 minutes after you take this medication.

POTASSIUM SUPPLEMENT

Adrenalectomy a surgical removal of adrenal glands.

SURGICAL MANAGEMENT

Advise to low salt diet contains less than 1,500 mg (1.5 grams) of salt per day. One teaspoon of salt contains about 2,300 mg of sodium.

Avoid cooking with salt.

Avoid fast food.

Avoid salty foods.

NURSING RESPONSIBILITIES

Avoid seasonings that contain sodium.

Promote exercise, achieve healthy weight.

Advise smoke cessation.

Avoid alcohol and limit caffeine.

Altered fluid and electrolyte balance

Fluid volume excess related to sodium and water retention associated with an increased aldosterone level resulting from activation of the renin-angiotensin-aldosterone mechanism as a result of decreased renal blood flow (occurs because of a decrease in intravascular volume that results from vasodilation and from third-spacing and sequestration of fluid in the splanchnic system)

NURSING DIAGNOSIS

Decreased cardiac output related to vasoconstriction

Knowledge deficit related to lack of information about the disease process and self-care

NURSING DIAGNOSIS

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