The clinical presentation of familial
hyperaldosteronism is not distinctive, and diagnosis requires expertise on
the part of the physician. Familial hyperaldosteronism patients usually have
a long history of fatigue, muscle loss, paresthesia (even paralysis),
tinnitus, and headache (caused by hypertension). Polyuria and polydipsia are
common features. The main physical symptom is hypertension. It is not
unusual for the diagnosis to be established when a severe complication of
hypertension occurs (stroke, cardiac problem). Laboratory examinations
reveal hypokalemia (often severe), metabolic alkalosis, inappropriate
kaliuresis, decreased plasma rennin activity, and high basal plasma levels of
aldosterone. Imaging reveals either diffuse adrenocortical hyperplasia or
multiple adrenocortical adenomas. Depending on the efficacy of
glucocorticoid given to correct the symptomatology, two types of this
familial disease exist: type I, which is glucocorticoid sensitive and caused by
multiple adrenocortical adenomas, and type II, which is caused by adrenal
hyperplasia and is not glucocorticoid remediable. Otherwise the two forms
are clinically similar.