Tag: Conn’s syndrome

Conn’s syndrome

Conn’s syndrome

Q. 1

Spironolactone is used in the treatment of patients with Conn’s syndrome. Which of the following is the MOST important adverse reaction of spironolactone therapy?

 A

Antiandrogen

 B

Cardiac arrhythmia

 C

Dehydration

 D

Hyperkalemia

Q. 1

Spironolactone is used in the treatment of patients with Conn’s syndrome. Which of the following is the MOST important adverse reaction of spironolactone therapy?

 A

Antiandrogen

 B

Cardiac arrhythmia

 C

Dehydration

 D

Hyperkalemia

Ans. A

Explanation:

Spironolactone is a competitive antagonist of the aldosterone receptor. Hypokalemia and hypertension in patients with primary aldosteronism can be controlled by spironolactone, 50-100 mg/d. Although spironolactone is an effective aldosterone receptor antagonist, it is not without side effects that can limit its use in the chronic treatment of this disease. The most important are anti-androgenic reactions.

Spironolactone acts as an antiandrogen by decreasing the production of testosterone by the adrenal gland and by preventing DHT (dihydrotestosterone) from binding to its androgen receptor. As a result of this, in the long run, gynecomastia occurs in more than 10% of the treated men. Impotence, loss of libido, and menstrual irregularities are also common side effects of spironolactone therapy. On the other side, these spironolactone features are the basis for its usage in the treatment of hirsutism, acne, and alopecia.

Spironolactone is also used by transsexuals in the feminizing regimen because of its anti-androgenic actions. 

Cardiac arrhythmia is not a frequent adverse reaction to spironolactone treatment, and it is seen only in the presence of significant hyperkalemia.

Dehydration is usually very mild, and can be prevented with adequate water intake.

Hyperkalemia develops in 5-10% of treated patients, especially if renal function is compromised, or the patient is diabetic, or elderly.

Also Know:

Spironolactone (Aldactone) is a direct aldosterone receptor antagonist in collecting tubules. It acts to inhibit aldosterone-mediated Na+ reabsorption and K+ secretion.
 
Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 31. Renal Physiology & Anesthesia. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e

Q. 2

Conn’s syndrome is associated with all the following, except:

 A

Hypertension

 B

Hypokalemia

 C

Muscle weakness

 D

Metabolic acidosis

Q. 2

Conn’s syndrome is associated with all the following, except:

 A

Hypertension

 B

Hypokalemia

 C

Muscle weakness

 D

Metabolic acidosis

Ans. D

Explanation:

Conn’s syndrome is associated with metabolic alkalosis, not with metabolic acidosis. Conn’s syndrome refers to primary hyperaldosteronism due to an adrenal adenoma. Increased aldosterone secretion results in hypokalemia from increased excretion of potassium and metabolic alkalosis due to increased hydrogen ion secretion.

Ref: Harrisons Internal Medicine, 18th Edition, Pages 2949-2951 ; Hypertension By Joseph Cheriyan, Page 148 ; Mosby’s Handbook Of Diseases By Rae Langford, 3rd Edition, Page 28


Q. 3

Conn’s syndrome is most commonly associated with:

 A

Cortical adenoma

 B

Cortical hyperplasia

 C

Cortical carcinoma

 D

Pheochromocytoma

Q. 3

Conn’s syndrome is most commonly associated with:

 A

Cortical adenoma

 B

Cortical hyperplasia

 C

Cortical carcinoma

 D

Pheochromocytoma

Ans. A

Explanation:

Answer is A (Cortical adenoma):

Conn’s syndrome by defination refers to primary aldosteronism secondary to an aldosterone producing adrenal adenoma. The most common aldosterone producing adrenal tumor is a unilateral adrenal adenoma.

Adrenal carcinoma is a rare cause of primary aldosteronism. Primary Aldosteronism secondary to bilateral cortical hyperplasia is not defined as Conn’s syndrome.

Primary Aldosteronism

Associated Adrenal Tumor

  • Adrenal Adenoma (Conn’s syndrome)
  • Adrenal carcinoma (Rare cause)

According to Harrisons 17th edition the most common cause of Conn’s syndrome is an aldosterone producing adrenal adenoma.

Most cases are unilateral() with a smallQ adenoma which may occur on either side.

Without Associated Adrenal tumor

  • Bilateral Cortical Hyperplasia

(Idiopathic Hyperoldosteronism)/Nodular hyperplasia) According to Harrisons I7th edition the most common cause for primary Hyperaldosteronism is Bilateral cortical Hyperplasia. `These patients constitute 80% of patients with Primary Hyperaldosteronism’ (Harrison)


Q. 4

Conn’s syndrome is associated with all, except :

 A

Hypertension

 B

Muscle weakness

 C

Hypokalemia

 D

Edema

Q. 4

Conn’s syndrome is associated with all, except :

 A

Hypertension

 B

Muscle weakness

 C

Hypokalemia

 D

Edema

Ans. D

Explanation:

Answer is D (Edema):

`Patients with primary aldosteronism (Conn’s syndrome) characteristically do not have edema since they exhibit an “escape” phenomenon from the sodium retaining aspects of mineralocorticoids’

Quiz In Between


Q. 5

In Conn’s syndrome the following is true:

 A

Diastolic HTN without oedema

 B

Systolic HTN without oedema

 C

Pseudotetany

 D

Hyper K+

Q. 5

In Conn’s syndrome the following is true:

 A

Diastolic HTN without oedema

 B

Systolic HTN without oedema

 C

Pseudotetany

 D

Hyper K+

Ans. A

Explanation:

Answer is A (Diastolic hypertension without edema):

Conn’s syndrome is characterized by diastolic hypertension without edema.


Q. 6

Conn’s syndrome is characterized by diastolic hypertension without edema.

 A

Hypokalemia

 B

Hyperkalemia

 C

Sodium retention

 D

Hypertension

Q. 6

Conn’s syndrome is characterized by diastolic hypertension without edema.

 A

Hypokalemia

 B

Hyperkalemia

 C

Sodium retention

 D

Hypertension

Ans. A

Explanation:

Answer is A

Excess Aldosterone is associated with Hypokalemia and not Hyperkalemia.


Q. 7

True about Conn’s syndrome

 A

TK+

 B

Proximal myopathy

 C

Ted plasma rennin activity

 D

Edema

Q. 7

True about Conn’s syndrome

 A

TK+

 B

Proximal myopathy

 C

Ted plasma rennin activity

 D

Edema

Ans. B

Explanation:

Answer is B (Proximal myopathy):

Conn syndrome is associated with hypokalenzia and muscle weakness (proximal myopathy)

Patients with Conn’s syndrome characteristically do not have edema, and Plasma rennin activity is typically low (decreased).


Q. 8

Which of the following is seen in Conn’s syndrome:

September 2007

 A

Water retention

 B

Hypernatremia

 C

Hyperkalemia

 D

Edema

Q. 8

Which of the following is seen in Conn’s syndrome:

September 2007

 A

Water retention

 B

Hypernatremia

 C

Hyperkalemia

 D

Edema

Ans. B

Explanation:

Ans. B: Hypernatremia

Conn’s syndrome is primary hyperaldosteronism due to Aldosterone producing adenoma (50%)

Clinical presentation

  • Usually occurs between 30 and 60 years
  • Conn’s syndrome accounts for 1% of cases of hypertension
  • Hypertension often responds poorly to treatment
  • Biochemically there is usually a hypokalaemic alkalosis (as hypersecretion of aldosterone increases the renal distal tubular exchange of intratubular sodium for secreted potassium and hydrogenions, with progressive depletion of body potassium and development of hypokalemia)
  • Polyuria is due to impairment of urinary concentrating ability.
  • Edema is associated mainly with secondary aldosteronism.

Quiz In Between



Conn’s syndrome

Conn’s syndrome


CONN’S SYNDROME

  • Conn’s syndrome or primary hyperaldosteronism is by hypertension due to hypersecretion of aldosterone.

 Etiology-

  • PHA with hypokalemia is unilateral adrenocortical adenoma (most frequent).

Clinical features-

  • Females are more affected.
  • Seen between 30- 50 years of age.
  • Hypertension , hypokalemic alkalosis, hypernatremia
  • Headache
  • Muscle weakness (proximal myopathy), cramps.
  • Neurological events.
  • Polyuria, polydyspsia and nocturia
  • Diastolic hypertension without oedema.

 Investigations-

  • Assessment of aldosterone to plasma rennin activity (ARR ratio)
  • Conn’s adenomas are detected mostly

Treatment-

  • Bilateral hyperplasma- spironolactone
  • Antihypertensive drugs
  • Unilateral laproscopic adrenolectomy
  • Subtotal adrenal resection- Single Conn’s adenoma.

Exam Important

  • Conn’s syndrome or primary hyperaldosteronism is by hypertension due to hypersecretion of aldosterone.

Etiology-

  • PHA with hypokalemia is unilateral adrenocortical adenoma (most frequent).

Clinical features-

  • Females are more affected.
  • Seen between 30- 50 years of age.
  • Hypertension , hypokalemic alkalosis, hypernatremia
  • Headache
  • Muscle weakness (proximal myopathy), cramps.
  • Neurological events.
  • Polyuria, polydyspsia and nocturia
  • Diastolic hypertension without oedema.

Investigations-

  • Assessment of aldosterone to plasma rennin activity (ARR ratio)
  • Conn’s adenomas are detected mostly

Treatment-

  • Bilateral hyperplasma- spironolactone
  • Antihypertensive drugs
  • Unilateral laproscopic adrenolectomy
  • Subtotal adrenal resection- Single Conn’s adenoma.
Don’t Forget to Solve all the previous Year Question asked on Conn’s syndrome

Module Below Start Quiz

Malcare WordPress Security