Conn's syndrome

Question 1

define

Answer 1

primary aldosteronism

there is an excess of aldosterone

Question 2

causes

Answer 2

adrenal adenoma

bilateral adrenal hyperplasia

Question 3

what does increased aldosterone cause?

Answer 3

increased cardiac collagen
cytokine synthesis
sodium retention
altered endothelial function (vasoconstriction)
increased sympathetic flow

Question 4

presentation

Answer 4

significant hypertension
hypokalaemia
alkalosis

Question 5

diagnosis

Answer 5

aldosterone renin ratio
saline suppression test (failure to suppress by 50% with 2 litres of normal saline is positive)
confirm subtype with adrenal CT and adrenal vein sampling

Question 6

management

Answer 6

• surgery: laparoscopic adrenalectomy to remove adenoma in zona glomerulosa
• if bilateral adrenal hyperplasia use MR antagonists e.g. spironolactone/eplerenone