Recall Exercise: Primary Aldosteronism Answer Key

Directions: For mental exercises, try to recall as much information as you can in response to each question. You may write it down, if you like. Use your mouse to highlight the white space underneath the question to reveal the secret answer key. This exercise is designed to help nursing students recall information they know, and discover what information is still missing from memory.

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1. What is the purpose of Aldosterone?

↱  Pull sodium back into the body from the urine.  Excrete more potassium and hydrogen ions in the urine.  ↲

2. Where is Aldosterone produced?

↱  The cortex (outer layers) of the adrenal glands that rest on the top of each kidney.  ↲

3. What is the most significant indicator of primary aldosteronism?

↱  Hypertension.  ↲

4. What are some signs and symptoms of hypokalemia, a condition often seen with Primary Aldosteronism?

→ Muscle cramps or weakness

→ Fatigue

→ Constipation

→ Nausea and vomiting

→ Dysrhythmias

5. What are some additional signs and symptoms of primary aldosteronism?

→ Large volumes of dilute urine 

→ Abnormally concentrated blood 

→ Thirst (polydipsia)

6.  How does primary aldosteronism affect the pH?

↱  The excessive excretion of potassium and hydrogen ions in the urine leads to metabolic alkalosis.  Nausea and vomiting add to this problem by loss of stomach acid.  Low potassium levels lead to potassium leaving cells to replenish the blood, but when potassium leaves the cells, hydrogen ions enter.  Hydrogen ions are acidic.  The loss of these ions from the extracellular compartment adds to the alkalotic state.  ↲

7.  How does primary aldosteronism affect blood glucose?

↱  Elevated glucose. Glucose intolerance develops because low potassium levels lead to reduced insulin secretion.  ↲

8.  How does primary aldosteronism affect blood calcium levels?

↱  Lowers blood calcium.  ↲

9.  What are two tests to check for low calcium?

→ Trousseau Sign: tapping above the temporomandibular joint elicits momentary facial spasms on that side

→ Chvostek Sign: flexion of the wrist after application of inflated blood pressure cuff

10.  What are some signs and symptoms of low blood calcium?

↱  Numbness, tingling.  Tetany.  ↲

11.  How do we test for primary aldosteronism?

↱  We take a blood sample and compare the ratio of aldosterone to renin.  PAC: PRA.  Do not withhold antihypertensive medications for this test.  ↲

12. How do we treat primary aldosteronism?

↱  Surgical removal of one or both adrenal glands.  ↲

13. Your patient is considering having surgery to remove both adrenal glands.  What patient teaching is vital to help with making this decision?

↱  You will need hormone replacement therapy for the rest of your life.  ↲

14. What are some medications that a patient may need BEFORE having adrenal surgery?

→ Antihypertensive medications to combat the high blood pressure

→ Potassium sparing diuretics such as spironolactone (Aldactone)

→ Potassium supplements

→ Insulin to lower blood glucose

15. What are some medications that a patient may need AFTER having adrenal surgery?

→ Replacement corticosteroids

→ Fluids or vasopressors to maintain blood pressure

→ Insulin to lower blood glucose

16.  For patients who choose to forego surgery, what is the first line drug for treating primary aldosteronism?

↱  Spironolactone.  ↲

17. What labs need monitoring for patients being treated for primary aldosteronism?

↱  The non-surgical treatment for primary aldosteronism is spironolactone.  Spironolactone is a potassium-sparing diuretic.  While taking this medication it is important to monitor serum potassium level and creatinine.  Also, if the person is taking digoxin, watch for toxicity.  ↲