Conns Syndrome

Question 1

Definition

Answer 1

Primary hyperaldosteronism (increases Na+ reabsorption at DCT, K+ secretion at DCT + H+ secretion at collecting duct) independent of RAAS

Question 2

Epidemiology

Answer 2

2nd most common cause of HTN
Middle aged Adults

Question 3

Risk factors

Answer 3

Family history of early onset HTN

Question 4

Aetiology ( Primary Adrenal Gland and Secondary Renin)

Answer 4

Primary hyperaldosteronism = adrenal glands directly responsible for producing too much aldosterone = low serum renin
- bilateral hyperplasia 1/3
- adrenal adenoma 2/3 = Conns
Secondary hyperaldosteronism = excessive renin
- renal artery stenosis
- renal artery obstruction
- HF

Question 5

Pathophysiology

Answer 5

Disorder of adrenal cortex = high aldosterone = Na+ and water retention and K+ loss = hypokalaemia + HTN

Question 6

Signs (3 things).

Answer 6

HTN
Hypokalaemia
Metabolic alkalosis = H+ secretion by CD

Question 7

Symptoms

Answer 7

Fatigue
Mood disturbance
Paraesthesia + muscle cramps
Difficulty concentrating

Question 8

Diagnosis

Answer 8

FIRST LINE: Aldosterone: Renin ratio = HIGH
(Primary = high aldosterone, low renin
Secondary = high everything)
U+E = hypokalaemia, and hypernatraemia
- could have normal Na+ due to ‘aldosterone-escape’ mechanism = water absorbed with Na+ which causes increased hydrostatic pressure in peri-tubular capillaries causing sodium to leak back into tubule
GOLD STANDARD = Serum aldosterone not supressed by 0.9% saline or FLUDROCORTISONE
ECG - hypokalaemia
CT

Question 9

Treatment

Answer 9

FIRST LINE = Unilateral laparoscopic adrenalectomy
+ Aldosterone antagonist (SPIRONOLACTONE) - 4 weeks pre-op for bilateral hyperplasia or adenoma