2: Hyperaldosteronism (Conns Syndrome)

Question 1

What is hyperaldosteronism

Answer 1

excess secretion of aldosterone from the adrenal gland

Question 2

What is the most common cause of secondary HTN

Answer 2

hyperaldosteronism

Question 3

what are the two types of hyperaldosteronism

Answer 3

• Primary hyperaldosteronism

- Secondary hyperaldosteronism

Question 4

what are 3 causes of primary hyperaldosteronism

Answer 4

1. Solitary adrenal adenoma (Conns Syndrome)
2. Adrenal carcinoma
3. Bilateral adrenal hyperplasia

Question 5

what is a solitary aldosterone producing adenoma called

Answer 5

Conn’s syndrome

Question 6

what causes a 1/3 of hyperaldosteronism

Answer 6

Bilateral adrenal hyperplasia

Question 7

what is secondary hyperaldosteronism

Answer 7

high aldosterone due to excess renin secretion

Question 8

what are 5 causes of secondary hyperaldosteronism

Answer 8

• Renal-artery stenosis
• Accelerated HTN
• Diuretics
• CCF
• Hepatic Failure

Question 9

What is barter’s syndrome

Answer 9

AR Disorder causing congenital salt-wasting

Question 10

What mutation is present in Barter’s syndrome

Answer 10

Mutation in sodium chloride channels in ascending loop of Henley causing excretion and loss of water

Question 11

How does barter’s syndrome present

Answer 11

FTT
Polyuria
Polydipsia
Normotensive

Question 12

What is the distinguishing feature about Barter’s syndrome

Answer 12

Blood pressure will be normal

Question 13

Explain pathophysiology and metabolic abnormalities in Barter’s syndrome

Answer 13

Excretion of Na+ and Cl-. To try and retain sodium there is hyper-activation of Na+-K+ ATPase which causes hypokalaemia and metabolic alkalosis

Question 14

How does hyperaldosteronism present clinically

Answer 14

• Asymptomatic

- Secondary HTN

Question 15

What electrolyte abnormality is present in hyperaldosteronism

Answer 15

Hypoakalaemia

Question 16

How may hypokalaemia present clinically

Answer 16

Weakness
Arrhythmias 
Fatigue 
Headache 
Palpitations

Question 17

What is first-line investigation for Hyperaldosteronism

Answer 17

Aldosterone:renin ratio

Question 18

What does a high aldosterone to renin ratio indicate

Answer 18

Primary hyperaldosteronism

Question 19

Explain high aldosterone: renin in primary hyperaldosteronism

Answer 19

• Excess aldosterone secretion by adrenal glands

- High aldosterone negatively feedback to cause low renin

Question 20

If high aldosterone:renin ratio what investigation is ordered

Answer 20

CT Abdomen

Adrenal Vein Sampling

Question 21

What is HR-CT abdomen and adrenal vein sampling ordered for

Answer 21

Distinguish solitary adenoma (Conns) from bilateral adrenal hyperplasia

Question 22

What test is sometimes used in primary hyperaldosteronism

Answer 22

Saline Infusion Test

Question 23

Explain saline infusion test

Answer 23

Give 2L Saline over 4h

In a health individual this will suppress RAAS system. In primary hyperaldosteronism - aldosterone will remain high

Question 24

How is bilateral adrenal hyperplasia managed

Answer 24

Spironolactone (Aldosterone antagonist)

Question 25

How is Conn’s syndrome managed

Answer 25

Surgical removal