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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Aldosterone is a steroid hormone that facilitates the reabsorption of sodium and water and the excretion of potassium and hydrogen ions from the distal convoluted tubule and collecting ducts. Conn’s syndrome is characterized by increased aldosterone secretion from the adrenal glands.
Hypertension
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
This condition is most commonly due to a benign, unilateral, autonomous adenoma of the adrenal gland secreting aldosterone. This results in low renin levels, increased sodium levels and low potassium levels, particularly in patients who are taking diuretics. Importantly, most patients have normal plasma electrolytes at presentation. Conn’s syndrome accounts for 1% of patients with hypertension. Around 70% of cases are due to adrenal hyperplasia.
Hypertension
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
This condition is most commonly due to a benign, unilateral, autonomous adenoma of the adrenal gland secreting aldosterone. This results in low renin levels, increased sodium levels and low potassium levels, particularly in patients who are taking diuretics. Importantly, most patients have normal plasma electrolytes at presentation. Conn’s syndrome accounts for 1% of patients with hypertension. Around 70% of cases are due to adrenal hyperplasia.
Duplicated adrenal veins in primary aldosteronism misdiagnosed with ectopic aldosteronoma due to apparent bilateral aldosterone suppression
Published in Blood Pressure, 2023
Jingwen Yu, Cunxia Fan, Weiping Wei, Haiwei Liu, Tuanyu Fang, Huibiao Quan, Kaining Chen, Yuhai Zhang
Since the nodule from the right side is located quite close to the liver, with the presented apparent bilateral aldosterone suppression, we initially considered the diagnosis to be an ectopic aldosteronoma. An ectopic (accessory) adrenocortical tissue or adrenal rests may contribute to the appearance of apparent bilateral aldosterone suppression. The most common ectopic site is in close proximity to the adrenal glands and along the path of descent or migration of the gonads. The ectopic adrenal glands atrophy as we get older which makes them very difficult to find in adults [8]. The ectopic adrenocortical tissue can develop into hyperplasia or adenoma as normal adrenal glands do. Conn’s syndrome, Cushing’s syndrome, and virilization occur when the ectopic tissue secrets aldosterone, cortisol, and androgen [9]. Adrenal Rest tumours are rarely located in the liver [10]. Radiological findings are usually described as a low-density roundish lesion with a regular border, nourished by the hepatic arteries [11,12].
Secondary hypertension as a cause of treatment resistance
Published in Blood Pressure, 2023
Isabella Sudano, Paolo Suter, Felix Beuschlein
Overall, compared with its importance as the major secondary cause of hypertension, the currently available tools for diagnosis and treatment of primary aldosteronism are quite inefficient. These shortcomings relate in part to the heterogeneity of Conn’s syndrome. In epidemiological terms, there appears to be a continuous spectrum from low renin hypertension, normokalaemic Conn’s syndrome to hypokalaemic primary aldosteronism that makes cut-offs used for screening somewhat arbitrary. Likewise, based on histopathology of adrenal tissues resected during adrenalectomy, heterogeneity exists at multiple levels as aldosterone excess may be caused by micro- or macronodular hyperplasia or by a typical adrenal adenoma; the adjacent adrenal cortex may be atrophic, diffuse hyperplastic, or nodular hyperplastic [21].
The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up
Published in Blood Pressure, 2021
Ola Undrum Bergland, Camilla Lund Søraas, Anne Cecilie K. Larstorp, Lene V. Halvorsen, Ulla Hjørnholm, Pavel Hoffman, Aud Høieggen, Fadl Elmula M. Fadl Elmula
The design and rationale of the Oslo RDN study (Figure 1) have been described in detail [12,13]. In short, of 65 patients with apparent treatment-resistant hypertension who were referred for RDN, 45 patients were excluded after a thorough investigation, either due to secondary causes or after obtaining a normalised daytime ABPM following witnessed intake of drugs as previously described by us and detailed in the Online Supplement [14]. Thus, 20 patients were randomised to either RDN or drug adjustment assisted by hemodynamic assessments using the HOTMAN system (Hemo Sapiens Inc. Sedona, AZ), described in detail by others [15]. Treatment was at all times in accordance with the latest guidelines of the European Society of Hypertension/European Society of Cardiology Guidelines on arterial hypertension [16–18]. One patient from the RDN group was diagnosed with Conn’s syndrome after randomisation and was subsequently excluded. All patients were planned for long-term follow-up after 3 and 7 years.