questions 3

Hyperaldosteronism / Conn's Syndrome

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Topic updated on 05/12/15 11:06am

Snap Shot
  • A 27-year-old male presents with headaches, muscle weakness, and high blood pressure. A basic metabolic panel showedNa+ of 151 and K+ of 3.1. CT of the abdomen is given at right.
Introduction
  • A disease caused by overproduction of aldosterone
  • May be of primary or secondary causes
    • primary hyperaldosteronism 
      • direct secretion of unregulated aldosteronism
      • majority are caused by unilateral adrenal (zona glomerulosal) adenoma 
        • also known as Conn's syndrome
      • also bilateral adrenal hyperplasia of zona glomerulosa
    • secondary hyperaldosteronism
      • increased secretion of aldosterone as a result of increased stimulation by renin
      • seen in renal artery stenosis and CHF
        • the kidneys see an effective "low circulating volume state" and respond by activating the renin-angiotensin-aldosterone axis.
Presentation
  • Symptoms
    • headache
    • muscle weakness
      • secondary to hypokalemia
  • Physical exam
    • hypertension
      • hypernatremic hypertension
    • tetany
      • secondary to hypokalemia
Evaluation
  • Labs
    • hypokalemia
    • +/- hypernatremia
      • hypernatremia is rarely found due to compensatory diuresis and resulting sodium loss secondary to increased circulating volume.
    • plasma renin
      • primary hyperaldosteronism
        • low renin 
          • negative feedback inhition by high aldsterone
      • secondary hyperaldosteronism
        • high renin
    • elevated 24-hour urine aldosterone
    • metabolic alkalosis
      • due to dumping of H+ for Na+
Treatment
  • Spirolactone
    • indications
      • indicated to normalize blood pressure and hypokalemia 
    • mechanism
      • spirolactone is an aldosterone receptor antagonist


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Qbank (2 Questions)

TAG
(M1.EC.42) A 47-year-old male presents with a primary complaint of generalized muscle weakness. Serum chemistry analysis reveals a pH of 7.6 and a potassium level of 3.2 mEq/L. Abdominal CT imaging is positive for a 1.5 cm nodule noted in the cortical region of the right adrenal gland and is shown in Figure A. Which of the following findings are most likely to be seen in this patient? Topic Review Topic
FIGURES: A          

1. Increased secretion of renin by the renal juxtaglomerular cells
2. Increased serum levels of 17-hydroxyprogesterone and deficiency of 21-hydroxylase
3. Hypotension secondary to decreased plasma aldosterone levels
4. Hypertension with low plasma renin activity
5. Increased fractional excretion of sodium (FENa) and associated hyponatremia

PREFERRED RESPONSE ▶
TAG
(M1.EC.57) A 33-year-old male presents to his primary care physician with complaints of headaches and muscle weakness. His physical exam is entirely within normal limits except for a blood pressure of 150/95. Subsequent routine blood lab work showed a sodium level of 146 and potassium level of 3.0. What is the best pharmacological therapy for this patient? Topic Review Topic

1. Hydrochlorthiazide
2. Spironolactone
3. Propanolol
4. Lisinopril
5. Fludrocortisone

PREFERRED RESPONSE ▶
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