Conn's syndrome

Question 1

what are the four main disorders of adrenocortical function?

Answer 1

Question 2

what’s the difference between primary (Conn’s) and secondary hyperaldosteronism?

Answer 2

Question 3

what’s the expected levels of potassium in Conn’s disease?

Answer 3

Question 4

what are the two main types of corticosteroid produced by the adrenal cortex? production of which one is affected in Conn’s?

Answer 4

aldosterone (hyperaldosteronism)

Question 5

What are the two main causes of hyperaldosteronism?

Answer 5

• adrenal adenoma (80%)
• adrenal hyperplasia (20%)

Question 6

where does aldosterone act on the nephron?

Answer 6

DCT

Question 7

why might a patient with Conn’s present with metabolic alkalosis?

Answer 7

• aldosterone increases activity of Na+/H+ pumps in renal tubules
• increases excretion of H+

Question 8

what’s the most clinically important differential diagnosis of hyperaldosternosim?

Answer 8

renal artery stenosis (RAS) - decreased perfusion of kidneys leads to renin and therefore aldosterone release

Question 9

what drug can be used to combat hyperaldosteronism?

Answer 9

spironolactone (aldosterone antagonist)

Question 10

what’s an alternative potassium sparing diuretic to spironolactone?

Answer 10

amiloride

Question 11

main two strategy pathways for treating Conn’s?

Answer 11

• surgical - if caused by adenoma
• medicinal - aldosterone antagonist e.g spironolactone or amiloride

Question 12

what are three side effects of spironolactone?

Answer 12

• gynaecomastia
• menstrual irregularities
• erectile dysfunction

Question 13

A 29-year-old gentleman, with no past medical history and is otherwise asymptomatic, has a markedly raised blood pressure incidentally diagnosed by his GP. He was referred by his GP to secondary care to investigate for secondary causes of hypertension. Noticing in the preliminary blood tests that the patient’s serum sodium was raised at 149 mmol/L while his serum potassium was reduced at 3.3 mmol/L, the consultant cardiologist suspects primary hyperaldosteronism (Conn’s syndrome) and sends off a renin-to-aldosterone ratio test among other investigations.

Which of the following is the single most likely result of the renin-to-aldosterone ratio test?

-Low renin, low aldosterone
-Normal renin, normal aldosterone
-High renin, low aldosterone
-High renin, high aldosterone
-Low renin, high aldosterone

Answer 13

Question 14

Answer 14

Question 15

Answer 15