Updated: 8/5/2019

Hyperaldosteronism / Conn Syndrome

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Snapshot
  • A 27-year-old male presents with headaches, muscle weakness, and high blood pressure. A basic metabolic panel showedNa+ of 147 and K+ of 3.1. CT of the abdomen demonstrates bilateraly adrenal hyperplasia.
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
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 inhibition by high aldosterone
      • secondary hyperaldosteronism
        • high renin
    • elevated 24-hour urine aldosterone
    • metabolic alkalosis
      • due to dumping of H+ for Na+
Treatment
  • Spironolactone
    • indications
      • indicated to normalize blood pressure and hypokalemia
    • mechanism
      • spironolactone is an aldosterone receptor antagonist
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(M1.EC.13.57) 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? Tested Concept

QID: 100573
1

Hydrochlorthiazide

6%

(2/32)

2

Spironolactone

94%

(30/32)

3

Propanolol

0%

(0/32)

4

Lisinopril

0%

(0/32)

5

Fludrocortisone

0%

(0/32)

M 2 D

Select Answer to see Preferred Response

(M1.EC.12.42) 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? Tested Concept

QID: 100343
FIGURES:
1

Increased secretion of renin by the renal juxtaglomerular cells

14%

(14/102)

2

Increased serum levels of 17-hydroxyprogesterone and deficiency of 21-hydroxylase

7%

(7/102)

3

Hypotension secondary to decreased plasma aldosterone levels

13%

(13/102)

4

Hypertension with low plasma renin activity

62%

(63/102)

5

Increased fractional excretion of sodium (FENa) and associated hyponatremia

4%

(4/102)

M 2 D

Select Answer to see Preferred Response

Evidence (5)
Topic COMMENTS (18)
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