Conns Syndrome Affects Mainly Younger Patients - Essay Example

The young patient suffers from a type of muscle weakness that is only linked with hypertension; however, there was no family history of hypertension.

With Conn’s Syndrome, hypokalemic metabolic alkalosis may be present; this can lead to muscle weakness, which has also been diagnosed in this patient. Further explanation about hypokalemic metabolic alkalosis will be given later.
This patient also shows symptoms of hypertension. For almost 95 percent of these types of cases, the cause of hypertension is unknown. On the other hand, hypertension can sometimes only be the secondary cause of pain and discomfort, and this seems to be true in this case. An initial diagnosis reveals that the patient is suffering from excessive secretion of aldosterone; this can increase renin levels and thus result in additional salt and water retention (Davidson Medicine 2010, p. 778).
Further details of this discussion will follow in the discussion of pathogenesis.

Lab Results

For this case, three lab results were taken: the levels of Sodium (146mmol/L), Potassium (2.1mmol/L), and Urea (7.2 mmol/L). The potassium levels in this patient seem to be below average, while the patient has a hypokalemic where sodium levels are very high as well as the urea levels. When these lab findings are correlated to the patient’s clinical history, Conn’s Syndrome is likely a result of excessive salt and water retention (Kumar and Clark 2011, p.657).

Pathogenesis

There is a difference between secondary hyperaldosteronism resulting from excessive renin from primary hyperaldosteronism, which can be caused due to adrenal hyperplasia, or primary adenoma of the adrenal gland. As the patient has a short medical history, she most likely has Conn’s Syndrome or adenoma. If this is so, then there would then be excessive secretion of aldosterone, which would function in the kidney’s distal tubule. As a result, this would likely cause the absorption of sodium and a loss of the potassium ion. Hypokalemia can cause metabolic alkalosis, which in turn can result in muscle weakness and may even cause tetany in rare cases. An increase in sodium would also result in greater absorption of sodium ions. Thus, this would dilute the intravascular compartment and cause hypertension as a result. However, extreme hypertension crises are hardly ever seen in these conditions. This can also present itself as polyuria due to an increase in the intravascular compartment and tubular damage that produces nephrogenic diabetes insipidus (Davidson Medicine 2010, p. 778). There may be other minor pathogenic pathways, like the activation of the mineralocorticoid receptor pathway, in the distal nephron. This may be true even with a low concentration of aldosterone; however, these cases are very rare.

Further Lab Diagnosis

Initial testing should have been carried out for electrolyte levels. After a preliminary hypothesis of Conn’s Disease, renin and aldosterone levels need to be checked out.

The Aldosterone to Rennin Ratio (ARR) is the main screening test for many of the patients who are suspected of suffering from any of these diseases. An abnormal ratio does not confirm the diagnosis and more testing should be done to ensure that the initial diagnosis is correct. However, there is some caution needed. Hypertensive medicine can alter the ratio, so consumption of medicine needed to be halted for two weeks before taking the test. Although the hypertensive ratio is important, for this ratio alpha-blockers should be given. Oral potassium can also be offered, as hypokalemia can disturb the hormone levels.
Next, come suppression and stimulation tests. Aldosterone levels are either reduced through the infusion of 0.9 percent saline, which must only be a maximum of 2 liters within a space of four hours. Stimulation tests can be carried out with captopril, while abnormal levels will support the initial diagnosis.
For additional treatment, a CT or MRI scan can also be helpful. It is also possible to see false positive results due to the non-functional adrenal gland and false negative tests because of insufficient resolution. If required, adrenal vein catheterization can also be carried out. Read More

 

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