Conn's syndrome

Question 1

What are the two functions of aldosterone?

Answer 1

1. Stimulate Na+/K+ pump on principal cells on DCT - more Na+ in - increase in BP
2. Stimulate ATPase proton pump in alpha-intercalated cells More protons are excreted in the urine - blood higher pH

Question 2

What is primary hyperaldosteronism?

Answer 2

Excess production of aldosterone, independent of RAAS = more Na+, water retention and lower renin

Question 3

What is Conn’s syndrome?

Answer 3

An adrenal adenoma that secretes aldosterone

Question 4

What are the three presenting features of hyperaldosteronism?

Answer 4

• Hypertension
• Metabolic alkalosis
• Hypokalaemia

Question 5

What symptoms are associated with hypertension?

Answer 5

• Headaches

- Flushing

Question 6

What symptoms are associated with hypokalaemia?

Answer 6

• Weakness/cramps,
• Paraesthesia,
• Polyuria and polydipsia (thirst)
• Constipation
• Heart rhythm changes

Question 7

What signs would you see on an ECG if hyperkalaemia was present?

Answer 7

• Flat T waves, ST depression and long QT

Question 8

What is the initial screening test for hyperaldosteronism? What should be stopped 6 weeks before the test and what would you see in the results?

Answer 8

• Plasma aldosterone: renin ratio
• Spirolactone and eplerenone
• Aldosterone is much higher

Question 9

What is the diagnostic test for hyperaldosteronism?

Answer 9

Increased plasma aldosterone levels that are not suppressed with 0.9% saline infusion or fludrocortisone administration (a mineralocorticoid)

Question 10

What treatment is used in hyperaldosteronism?

Answer 10

Laproscopic adrenalectomy

Question 11

What is given alongside surgery in Conn’s syndrome?

Answer 11

Aldosterone antagonist e.g. ORAL SPIRONOLACTONE for 4 wks pre-op to control BP and K+, as spironolactone is a K+ sparing diuretic