Endocrine System >
Conn’s Syndrome

“Syndrome of excess production of aldosterone independent of the renin-angiotensin system (primary hyperaldosteronism)”

Risk Factors
  • Family history of primary hyperaldosteronism
  • Family history of hypertension or stroke at <40 years old.
Aetiology
  • Solitary aldosterone-producing adrenal adenoma.
    • Primary hyperaldosteronism can also be due to bilateral adrenal hyperplasia and, rarely, familial hyperaldosteronism.
Pathophysiology
  1. Increased aldosterone levels.
  2. Increase in the number of sodium channels in the distal convoluted tubule of renal nephrons.
  3. Increased sodium and water reabsorption and increased potassium excretion.
  4. Negative feedback decreases renin production.
Clinical Presentation
  • Often asymptomatic.
  • Hypokalaemia:
    • Fatigue
    • Muscle weakness
    • Cramps
    • Tetany
    • Palpitations
    • Constipation
    • May develop hypokalaemia induced diabetes insipidus (polyuria and polydipsia).
  • Hypertension (secondary):
  • Refractory to at least 3 medications
  • Occurring <40 years old or associated with hypokalaemia

Investigations
  • Blood pressure (↑)
  • U&Es (potassium↓)
  • Serum aldosterone – renin ratio (↑)
  • Adrenal vein sampling (compare sides; unilateral or bilateral)
  • CT abdomen
  • Serum aldosterone (↑)
  • 24hr urinary aldosterone excretion (↑)
  • ECG (changes due to hypokalaemia)
  • ABG (metabolic alkalosis due to hypokalaemia)
Management
  • Laparoscopic adrenalectomy
  • Aldosterone antagonists (e.g. spironolactone) given for 4 weeks pre-op
Complications
  • Myocardial infarction
  • Arrhythmias
  • Heart failure
  • Stroke
  • Kidney failure
  • Retinopathy

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