Conn's Syndrome

Question 1

what is the definition of conn’s syndrome?

Answer 1

• Primary hyperaldosteronism:

• Excess production of aldosterone, independent of the renin-angiotensin system
• Resulting in increased sodium and thus water retention (resulting in increased BP), and decreased renin release

Question 2

what is the epidemiology of conn’s syndrome?

Answer 2

rare, <1% of all hypertension

Question 3

what is the aetiology of conn’s disease?

Answer 3

• 2/3rds - Adrenal adenoma that secretes aldosterone - Conn’s syndrome
• 1/3rd - Bilateral adrenocortical hyperplasia

Question 4

what are the risk factors for conn’s disease?

Answer 4

• Hypertension in patients:
  • Under 35 yrs with no family history of hypertension
  • With accelerated (malignant) hypertension
  • With hypokalaemia before diuretic therapy
  • Resistant to conventional antihypertensive therapy e.g. more than 3 drugs
  • With unusual symptoms e.g. sweating attacks or weakness

Question 5

what is the brief pathophysiology of conn’s disease?

Answer 5

Disorder of the adrenal cortex characterised by excess aldosterone production leading to Na+ and water retention and K+ loss (since need to balance charge) and the combination of hypokalaemia and hypertension due to aldosterone producing carcinoma (Conn’s) or adrenocortical hyperplasia

Question 6

what are the key presentations of conn’s disease?

Answer 6

often asymptomatic, hypertension, hypokalaemia

Question 7

what are the signs of conn’s disease?

Answer 7

high blood pressure, hypokalaemia

Question 8

what are the symptoms of conn’s disease?

Answer 8

Weakness and cramps, paraesthesia (pins and needles), polyuria, polydipsia

Question 9

what are the first line investigations for conn’s disease?

Answer 9

Hypokalaemic ECG:

• Flat T waves, ST depression and long QT

Question 10

what are the gold standard investigations for conn’s disease?

Answer 10

• Serum hypokalaemia - but not always present
• Plasma aldosterone: renin ratio (ARR): - GOLD STANDARD
  • Initial screening test
  • Spirolactone and eplerenone should be stopped 6 weeks before test
  • Aldosterone is much higher - NOT DIAGNOSTIC, used mainly for screening
• Increased plasma aldosterone levels that are not suppressed with 0.9%
  saline infusion or fludrocortisone administration (a mineralocorticoid) - DIAGNOSTIC

Question 11

what are the other tests for conn’s disease?

Answer 11

CT or MRI adrenals to differentiate adenomas from hyperplasia

Question 12

what are the differential diagnoses for conn’s disease?

Answer 12

• Must be differentiated from secondary hyperaldosteronism which arises where there is excess renin (and hence angiotensin II) which stimulates aldosterone release
  • Caused by reduced renal perfusion which can be due to:
• Renal artery stenosis
• Accelerated hypertension
• Diuretics
• Congestive cardiac failure
• Hepatic failure

Question 13

how is conn’s disease managed?

Answer 13

• Laproscopic adrenalectomy

- Aldosterone antagonist e.g. ORAL SPIRONOLACTONE for 4 wks pre-op to control BP and K+

Question 14

how is conn’s disease monitored?

Answer 14

regular blood and urine tests

Question 15

what are the complications of conn’s disease?

Answer 15

The hypokalemia (low potassium level) can cause symptoms like fatigue, numbness, increased urination, increased thirst, muscle cramps, and muscle weakness. 
Hyperaldosteronism leads to an increased risk for heart attacks, heart failure, strokes, kidney failure, and early death

Question 16

what is the prognosis of conn’s disease?

Answer 16

Without proper treatment, patients with hyperaldosteronism often suffer from poorly controlled high blood pressure and are at increased risk for heart attacks, heart failure, strokes, kidney failure, and early death. However, with appropriate treatment, this disease is treatable and has an excellent prognosis