Conn's Syndrome/Primary Hyperaldosteronism

Question 1

MOA of aldosterone

Answer 1

stimulates distal tubule of nephron to resorb sodium and excrete potassium and hydrogen

Question 2

Signs of Conn’s syndrome?

Answer 2

refractory HTN, muscle cramping/weakness, profound hypokalemia if on diuretics

Question 3

What is the size cut-off for a functioning adenoma and the suspicion of malignancy?

Answer 3

Benign, aldosterone-secreting adenomas are < 3 cm

Question 4

Lab findings of Conn’s syndrome

Answer 4

hypokalemia, alkalosis (higher pH), hypernatremia, low renin, high serum aldosterone

Question 5

Screening test for Conn’s syndrome?

Answer 5

• Serum potassium levels ( < 3 suggestive)

* aldosterone:plasma renin activity ratio ( > 20:1)

Question 6

Confirmatory test for Conn’s syndrome?

Answer 6

*Urinary aldosterone excretion +/- sodium loading x 3 days

Adrenal venous sampling to lateralize etiology of hyperaldosteronism when imaging is unclear

Question 7

Treatment of Conn’s?

Answer 7

Unilateral = adrenalectomy
- pre-operative K-sparing diuretics (spironolactone or Eplerenone)

Bilateral adrenal hyperplasia = K-sparing diuretics, non-surgical management