Adrenal Gland Disorders: Hyperaldosteronism and Pheochromocytoma

Hyperaldosteronism

Concept:

A disorder of the adrenal gland that releases large amounts of aldosterone into the bloodstream.

Types:

• Primary Hyperaldosteronism: Overproduction of aldosterone by a disorder of the adrenal gland.
• Secondary Hyperaldosteronism: An increase in aldosterone and renin due to activation of the renin-angiotensin system.

Etiology:

Primary Hyperaldosteronism:

• Adrenal adenoma (Conn's Syndrome)
• Bilateral adrenal hyperplasia
• Unilateral adrenal hyperplasia
• Adrenal carcinoma

Secondary Hyperaldosteronism:

• Increased production of renin by the kidney
• Hypersecretion of renin (e.g., Bartter's Syndrome)

Epidemiology:

Primarily affects women between 30-50 years of age.

Clinical Manifestations:

• Hypertension
• Hypernatremia (increased sodium)
• Hypokalemia (decreased potassium)
• Muscle weakness
• Fatigue
• Cramps
• Muscle paralysis
• Cardiac arrhythmias
• Polyuria
• Polydipsia

Prolonged hypokalemia may lead to postural hypotension, bradycardia, and edematous disorders in the feet and legs.

Diagnosis:

Diagnosis is based on laboratory and biochemical tests, physical examination, and patient history, allowing for differential diagnosis.

Treatment:

Primary Hyperaldosteronism (Conn's Syndrome):

• Surgery
• Restriction of salt intake
• Aldosterone antagonist diuretics to block the action of aldosterone

Secondary Hyperaldosteronism:

• Restriction of salt intake
• Diuretics

Prognosis and Evolution:

For Primary Hyperaldosteronism, the prognosis is usually good and will vary depending on the etiology.

Pheochromocytoma

Concept:

Pheochromocytomas are tumors, typically of the adrenal gland, that synthesize and release catecholamines.

Etiology:

Occurs in both sexes, typically between 30-50 years of age. Most pheochromocytomas contain and secrete noradrenaline and adrenaline.

Epidemiology:

Occurs primarily in the 4th and 5th decades of life. Approximately 10% occur in children, predominantly boys. In adults, 50-60% of cases are in women.

Clinical Manifestations:

• Hypertension
• Profuse sweating
• Palpitations
• Headache
• Chest or abdominal pain
• Cholelithiasis

Triggers:

• Medical procedures
• Digestive stimuli
• Emotional stress
• Medications

Diagnosis:

Diagnosis involves laboratory tests, CT scans, and MRI.

Treatment:

Surgical removal is the primary treatment. For pheochromocytoma during pregnancy, the patient is managed, and the tumor is surgically removed once located. Malignant pheochromocytomas require medical treatment.

Prognosis and Outcome:

The 5-year survival rate after surgery is 95% for benign cases and 50% for malignant cases.