Conns

Question 1

D?

Answer 1

Primary aldosteronism-overproduction of aldosterone, creating a clinical manifestation of several symptoms.

Question 2

RF?

Answer 2

• FH

* FH of stroke or HT

Question 3

ddx?

Answer 3

• Essential HT
• Hypokalaemia
• Secondary HT
• Liddle Syndrome
• CAH
• Glucocorticoid resistance
• Ectopic ACTH syndrome
• Mutations
• Psuedohypoaldosteronism

Question 4

Epidemiology?

Answer 4

Age:
Sex: Female for adenoma(2:1), male for adrenal hyperplasia (4:1)
Ethnicity: A/C

Question 5

Aetiology?

Answer 5

• Overproduction of aldosterone (mineralocorticoid)
• Bilateral idiopathic hyperplasia of adrenal glands
• Aldosteronoma
• Unilateral hyperplasia
• Familial hyperaldosteronism
• Carcinomas of adrenal cortex
• Ectopic aldosterone-producing tumours

Question 6

CP?

Answer 6

• Hypertension-drug-resistant
• Fatigue
• Muscle weakness/cramping
• Headaches
• Polyuria and polydipsia
• Palpitations
• Constipation
• Paraesthesia

Question 7

Pathophysiology?

Answer 7

• Aldosterone secretion usually regulated by RAAS
• Overproduction of aldosterone increases sodum reabsorption and water reabsorption despite normal BP-HT
• Aldosterone escape-increase in blood volume creates expansion that stimulates the ANP mechanism and pressure naturesis, so less fluid is retained in the interstitium so escape from oedema and hypernatremia
• More sodium reabsorption means more K removal via the Na/K pump so more is secreted causing hypokalaemia
• The H/K pump exchanges K for H into cells to increase the low K levels as well as the kidney secreting more H from the Na/H pump into the tubule-metabolic alkalosis

Question 8

I-first line?

Answer 8

• FBC
• U and E’s-hypokalaemia, hypernatremia, metabolic alkalosis
• Plasma potassium
• Aldosterone/renin ratio-low renin, high aldosterone
• 24-hr urinary aldosterone-high

Question 9

I-second line?

Answer 9

• CT scan-unilateral mass suggests adenoma
• Adrenal vein sampling- aldosterone:cortisol
• in bilateral adrenal hyperplasia the aldosterone:cortisol ratio is higher in each adrenal vein than in the inferior vena cava
• in unilateral adenomata the aldosterone:cortisol ratio is higher in the adrenal vein draining the adenoma than in IVC; the ratio is reversed in the contralateral adrenal
• Measure plasma aldosterone at 12 and 9 pm-higher to lower due to angiotensin II and ACTH regulation

Question 10

M-uni-first line?

Answer 10

• Unilateral laparoscopic adrenalectomy
  
  • Need sodium supplementation and fluids given after
• Pre-op aldosterone antagonists
  
  • Spironolactone
  • Amiloride-if sex steroid characteristics

Question 11

M-uni-second line?

Answer 11

• Aldosterone antagonists
  
  • Spironolactone
  • Amiloride-if sex steroid characteristics

Question 12

M-bi-<2.5cm?

Answer 12

• Aldosterone antagonists
• Laparoscopic adrenalectomy
  
  • The aim of adrenalectomy is to reduce the mass of adrenal tissue that is excessively and autonomously producing aldosterone, and thereby bring about improvements in BP levels and marked reductions in the doses of aldosterone antagonist medicines required to control hypertension
• Pre/post-op aldosterone antagonists

Question 13

M-bi->2.5cm?

Answer 13

• Unilateral laparoscopic adrenalectomy
  
  • Based on potential to be malignant
• Pre/post-op aldosterone antagonists

Question 14

M-familial hyperaldosteronism I?

Answer 14

• Glucocorticoids
• Aldosterone antagonists
  
  • Amiloride
  • Spironolactone

Question 15

P?

Answer 15

• All pts with unilateral cured or treated for HT after adrenalectomy
• HT improves bt less so with aldosterone antagonists on their own
Treatment for familial very effective

Question 16

Complications?

Answer 16

• Perioperative complications
• Stroke
• MI
• HF
• AF
• Impaired renal function
• hyperkalaemia