18. Primary hyperaldosteronism – Conn syndrome

Question 1

What is conn syndrome

Answer 1

Primary hyper aldosteronism

Question 2

What factors control the secretion if aldesterone ?

Answer 2

Angiotensin 2
Potassium
ACTH
RAS

Question 3

What causes primary hyperaldosteronism or conn syndrome

Answer 3

aldostronoma -aldosterone producing adenoma

Bilateral idiopathic adrenal hyperplasia

Question 4

What are the signs and symptoms of conn disease

Answer 4

Volume explanation - DRUG RESISTANT hypertension - headache

Hypokalemia
-cramps ,

parenthesis : severe metabolic alkalosis

mild Nephrogenic diabetes insipidus = polyuria +polydipsia

Glucose intolerance

Cardiac arrythmia

Aldosterone on cardiovascular :
Cardiac hypertrophy and fibrosis

Question 5

What is the clinical presentation of patients with their history when having conn disease ?

Answer 5

Long standing moderate to severe hypertension that is refractory to three or more blood pressure medicaments

Question 6

What is the diagnosis of conn disease ?

Answer 6

Plasma Aldosterone to renin activity ratio / or direct renin conc

If more than 1 ( more aldosterone and suppressed renin level )

Make sure to withdraw diuretics that can alter this ratio
Preferred alpha blockers - prazosin
Non dihydropyridine calcium channel blockers - slow release verapamil
Vasodilator - hydralazine
=no effects on aldosterone level

No use of ARB and ACE and postassoum wasting diuretics

————

Confirmatory rest to see if aldosterone secretion is suppresable
Not suppressed in true primary hyperaldosteronism
- saline infusion test , captopril test , oral sodium loading , fludrocortisone suppression test

Adrenal CT

Adrenal vein sampling

Question 7

What is a dd to conn syndrome ? And how can we differentiate ?

Answer 7

Secondary hyperaldosteronism

Activation of RAS - 
renal artery stenosis 
Congestive heart failure 
Cirrhosis or ascitis 
Renin-secreting tumor

• and unlike primary plasma renin activity not suppressed

Question 8

Treatment of conn disease ?

Answer 8

Unilateral laparoscopic adrenectomy
Prior to surgery, hypokalemia should be corrected with spironolactone and potassium supplementation.

Bilateral hyperplasia -
aldosterone antagonists - spirinolactone and eplerenone