Physiology
This was previously featured in an exam
Endocrine
A patient is sent to ED by her GP with severe hypertension. She has recently been diagnosed with Conn's syndrome. Which of the following clinical features might you expect in this patient:
Answer:
Features of Primary Hyperaldosteronism:- Hypertension
- Hypokalaemia
- Metabolic alkalosis
- Hypernatraemia (may be high end of normal or only mildly raised)
- Aldosterone levels high
- Renin levels low
Hyperaldosteronism
Physiology / Endocrine / Adrenal Function
Last Updated: 24th April 2020
Hyperaldosteronism can be defined as excessive levels of aldosterone which may be independent of the renin-angiotensin axis (primary hyperaldosteronism) or due to high renin levels (secondary hyperaldosteronism).
Pathophysiology
Excessive aldosterone levels act at the distal renal tubule, promoting sodium retention, which results in water retention and volume expansion with hypertension. There is also excretion of potassium, resulting in hypokalaemia.
Causes of Primary Hyperaldosteronism
- Adrenal adenoma (Conn's syndrome, accounts for >80% of cases of hyperaldosteronism)
- Adrenal hyperplasia
- Familial hyperaldosteronism
- Adrenal carcinoma
Features of Primary Hyperaldosteronism
- Hypertension
- Hypokalaemia
- Metabolic alkalosis
- Hypernatraemia (may be high end of normal or only mildly raised)
- Aldosterone levels high
- Renin levels low
Management of Primary Hyperaldosteronism
Medical management is used in the period prior to surgery - which is the definitive treatment. Medical management involves the use of aldosterone antagonists e.g. spironolactone. Surgical treatment involves adrenalectomy.
Report A Problem
Is there something wrong with this question? Let us know and we’ll fix it as soon as possible.
Loading Form...
- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
