Primary Hyperaldosteronism

Conn’s Syndrome
  • Non-suppressible hypersecretion of aldosterone
  • Many subtypes – most common are aldosterone-producing adenoma and bilateral idiopathic hyperaldosteronism
  • Hypertension and Hypokalemia are the two major clinical findings
  • Other findings include metabolic alkalosis, mild hypernatremia and hypomagnesemia
  • May be associated with resistant HTN – failure to achieve goal blood pressure despite adherence to appropriate three-drug regimen including a diuretic
Diagnosis
  • Begin with plasma renin activity and plasma aldosterone concentration
  • Increased plasma aldosterone to renin ratio and increased plasma aldosterone concentration are both required for the dx of primary aldosteronism
  • Further confirmatory tests include oral salt loading  or saline infusion test
  • Once Dx established – then unilateral aldosterone producing adenoma or carcinoma (rare) must be distinguished from bilateral hyperplasia using CT abdomen and adrenal vein sampling
  • Adrenal CT is the initial test but if CT scan is normal, then adrenal venous sampling to confirm disease especially if the patient would like to pursue surgical management

HyperAldo

Advice for Physicians in Training: 40 Tips From 40 Docs

Introducing our newest segment for the UT Southwestern Internal Medicine Blog: Advice for Physicians in Training (though some of this may apply to physicians already in practice)!

 

We present a “distillation of the advice and wisdom” of 40 practicing physicians, to be dispensed over the next 8 weeks. Look for a new pearl each day!

On Doctoring:

A thorough history almost always trumps a thorough physical examination. Osler said “Listen to the patient. He is telling you the diagnosis.” He was right.

Osler

David Juurlink, Advice for Physicians in Training: 40 Tips From 40 Docs,The Winnower2:e142006.67645 (2014). DOI:10.15200/winn.142006.67645

 

 

Antibiotics: when you need them—and when you don’t

It’s the middle of winter, with no end in sight. A 28 year old male arrives in your primary care clinic with no past medical history and one complaint: a stuffy nose. For the last 3 days, he has had sinus congestion, a mild cough, and associated headache. He denies fever, sick contacts, myalgias, etc. You suspect a viral infection, noting that the patient should improve without antibiotics, but he insists. He must have antibiotics today, so that he can return to work! Do you give in and send him out with a Z-pack?

Consumer Reports has joined with the ABIM and the Choosing Wisely Campaign to help educate patients about when, where, and how to use antibiotics, in an effort to prevent, as they note, unnecessary harm.

Take a look at the patient resources below – if you like them, print them out and display them in your practice. It just might make your next conversation a bit easier…

The PDF and the poster may help with patient education!

ChoosingWisely