HTN + hypokalemia + muscle weakness
Confirm: ↑aldosterone/renin ratio; replace potassium
Localize: Adrenal CT ± adrenal venous sampling
Treat: Adenoma → adrenalectomy; Bilateral → spironolactone / eplerenone
Order set
- Aldosterone/renin ratio
- K⁺ (replace)
- Adrenal CT
- Consider AVS
Criteria
AdmitSevere hypokalaemia/arrhythmia or malignant HTN
DischargeK⁺ replaced, BP controlled, localisation plan
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Severe hypokalaemia
- Resistant HTN
Differentials
- Essential HTN
- Renovascular HTN
- Liddle/Cushing
Common mistakes
- Testing on interfering drugs
- Skipping AVS before adrenalectomy
Disposition & follow-up
Adenoma → adrenalectomy; bilateral → MRA.
Discharge package
MedicationsMRA if bilateral; BP control
Follow-upEndocrine; BP + K⁺ monitoring
Warning symptomsWeakness, palpitations, very high BP
💊 Treatment detail — doses & preparation
SpironolactoneMRA
Dose25–50 mg OD (HF); 100–400 mg/day (hyperaldosteronism)
Preparation25/50/100 mg tablets
MonitorK⁺, creatinine at 3 d + 1 wk; gynaecomastia (eplerenone alternative)
EplerenoneMRA
Dose25–50 mg OD
Preparation25/50 mg tablets
MonitorK⁺, creatinine; fewer endocrine effects than spironolactone
Potassium chlorideelectrolyte
DosePO 40–100 mmol/day divided. IV: 10 mmol/h peripheral, 20 mmol/h central with cardiac monitor
PreparationIV: NEVER undiluted push — 10 mmol in 100 mL or 40 mmol/L bag via pump
MonitorK⁺ q4–6 h during replacement, ECG, urine output >0.5 mL/kg/h
Adrenalectomydefinitive
DoseUnilateral adenoma → laparoscopic adrenalectomy (cures HTN in ~50%)
PreparationPre-op K⁺ correction + spironolactone 4–6 wk
MonitorPost-op: stop MRAs, watch transient hypoaldosteronism
📖 Endocrine Society Primary AldosteronismReviewed July 2026