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Diagnosis This case will look at hyperaldosteronism or what is known as Conn’s Syndrome. History The young patient suffers from a type of muscle weakness that is only linked with hypertension; however, there was no family history of hypertension. The female patient is too young to suffer from hypertension, so it is not very likely that she has essential hypertension…
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Patients often suffer from muscle weakness. Generalized muscle weakness must always be balanced with calcium levels in the body. 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 with this case. An initial diagnosis reveals that the patient is suffering from excessive secretion of aldosterone; this can result in an increase of rennin 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 pathogensis. 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, it is likely that Conn’s Syndrome is 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 rennin 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 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 of 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, rennin 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 Read More
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