Hyperaldosteronism in children

　　The most common cause of hyperaldosteronism in children is adrenal cortical adenoma or hyperplastic adenoma. Adenomas are mostly solitary. Most pediatric cases are caused by bilateral adrenal cortical hyperplasia leading to increased secretion of aldosterone, the cause of which is unknown and is called congenital hyperaldosteronism.

　　In addition to its clinical manifestations, hyperaldosteronism in children can also cause other diseases. Long-term increased blood pressure in patients can lead to left ventricular hypertrophy and heart failure, with small artery spasm in the fundus, and occasional small hemorrhage.

　　The earliest symptom of primary hyperaldosteronism is hypertension. Blood pressure gradually increases with the development of the disease, and then gradually appears fatigue, dizziness, and abnormal sensation. For hypertension, hypokalemia, alkalosis, accompanied by polydipsia, polyuria, increased nocturia, and increased urinary potassium, primary aldosteronism should be suspected, and further examination is needed.

　　There is no definite preventive measure for hyperaldosteronism in children. Early detection, early diagnosis, and early treatment are of great significance in preventing the disease. Regular checks should be done during pregnancy. If the child shows a tendency of abnormal development, chromosome screening should be done in a timely manner, and if confirmed, an artificial abortion should be performed promptly to avoid the birth of a child with the disease.

　　In the diagnosis of pediatric hyperaldosteronism, in addition to relying on its clinical manifestations, chemical tests are also needed. The main inspection methods are as follows:

　　1. Blood Test

　　Serum potassium is usually below 3.5 mmol/L, some intermittent hypokalemia. Serum sodium is generally slightly higher than normal, above 140 mmol/L, but rarely greater than 148 mmol/L. Plasma renin-angiotensin activity is lower than normal.

　　2. Urine Test

　　Increased urine output, especially increased nocturnal urine output, low specific gravity, less than or equal to 1.010. Urine concentration test is negative. Some patients may also have proteinuria and/or increased urine leukocytes, increased urine potassium excretion.

　　3. Electrocardiogram

　　Changes in the electrocardiogram caused by hypokalemia are manifested as prolongation of the Q-T interval, widening, lowering, or inversion of the T wave, and the appearance or connection of T-U waves into a double peak.

　　4. Abdominal CT or MRI Scan

　　Abdominal CT or MRI scan can differentiate between adrenal adenoma or hyperplasia.

　　5. Kidney Ultrasound

　　Kidney ultrasonography can understand the condition of both adrenal glands.

　　Children with hyperaldosteronism should eat more mutton, loach, eggs, light seafood, donkey meat, tortoise, chive, chicken liver, fish liver, pork liver, and so on in their daily diet. The diet should be light and nutritious, and attention should be paid to dietary balance. Spicy and stimulating foods should be avoided to prevent recurrence of the disease. Eat more fresh vegetables and fruits, and eat more foods that enhance immunity to improve the body's resistance to diseases.

　　The main treatment methods for children with hyperaldosteronism are as follows:

　　1. Surgery

　　After the diagnosis of primary hyperaldosteronism, surgical treatment is required. When an adenoma is found, it should be removed. If both sides are hyperplastic, or one side has an adenoma with both sides hyperplastic, a unilateral total adrenalectomy and half of the other side can be performed, and an antagonist can be supplemented with treatment if necessary. For those who still have recurrent hypertension after subtotal resection of surgery, spironolactone to inhibit aldosterone secretion and low-salt diet have a good therapeutic effect.

　　2. Drug Treatment

　　For those caused by bilateral adrenal hyperplasia, surgery is generally not adopted and drug treatment is the main method. Currently commonly used drugs include spironolactone, angiotensin-converting enzyme inhibitors, sodium transport inhibitors, calcium channel blockers, serotonin antagonists, and others.