Conn's syndrome (Primary Hyperaldosteronism) - MADE EASY

hey guys today we're going to talk about hyperaldosteronism which we can divide into the primary also known as constant drum or secondary but before we get into that let's just talk about a normal patient with a low blood pressure when someone has low blood pressure we have these baroreceptors located in the afferent arterioles of the kidney they're located right here and they're going to sense these low blood pressure once they do they're going to secrete these enzymes called renin now what running does is that it converts angiotensinogen into angiotensin one and angiotensin one then travels to the lung and by using this enzyme called ace which stands for angiotensin converting enzyme it gets converted to angiotensin 2 now angiotensin 2 goes to the adrenal gland and it stimulates production of aldosterone now once our darshan is made is going to travel to distal convoluted tubules and the collecting duct and it's going to work on two different types of cells it's going to work on the principle cells and Alpha intercalated cells so let's imagine this is our aldosterone binding to its receptors and once it binds to these receptors it's going to activate these pumps in these cells now in principle cells we are going to reabsorb sodium and water always follow sodium and at the same time we're going to exchange that sodium with potassium so we're going to be secreting potassium in the lumen of the nephron and on the Alpha intercalated cells we're going to secrete hydrogen ions into the lumen so now what's going to happen is this sodium and water reabsorption will lead to increase of blood pressure so our initial low blood pressure will now become normal and it's important to know that once blood pressure is back to normal this whole system gets shut down and it will not go beyond this point because we're talking about a normal person let's now talk about primary or cons central first when we're saying primary what we mean is that the tumor is located at the site where the actual hormone is being made and secreted there's no other forces that are influencing it to do so so the tumor is located here in the adrenal gland and it's making loss of aldosterone now it could be on both adrenal glands or just on one so we can say primary is because of a unilateral or bilateral tumors so since the tumor is here we're going to be making lots and lots of our last run now this aldosterone is going to be doing its job which is to reabsorb sodium and water and excrete potassium and hydrogen so we're going to have hypernatremia hypertension due to sodium and water reabsorption we are also going to have hypokalemia and metabolic alkalosis the reason for hypokalemia and metabolic alkalosis is that we are losing potassium and hydrogen ions which are being excreted in the urine now what's really important here that we should understand is that since this is due to a tumor and it's a primary tumor the increase of aldosterone is going to have a negative feedback on production of renin so we're going to be inhibiting renin so in this in the case of a primary hyperaldosteronism aldosterone is going to be high but renin is going to be low now in the secondary we're not talking about a tumor it's another cause that that is making the adrenal gland to produce lots of aldosterone now some of those secondary causes are renal artery stenosis so if we have a razor constriction here there's going to be less blood getting to the kidneys now the kidney is going to think there's low blood pressure which might not be the case but it's kind of secrete lots of renin and this raining is going to lead to increase aldosterone production so we're going to have increased rain in due to the secondary cause and rain is going to lead to increase aldosterone some other causes for secondary hyperaldosteronism are congestive heart failure now if the heart is failing at pumping out blood this means that there's gonna be less blood get into the kidney kidney is gonna think low blood pressure so again it's kind of sickly lots of renin which kind of lead to increase a loss on production another reason could be due to cirrhosis and also nephrotic syndrome the reason for these two is that if you have cirrhosis or we have nephrotic syndrome we're going to lose a lot of proteins especially albumin and cirrhosis we're not going to make any protein in the product we're getting rid of so much protein so low serum protein concentration will eventually to decrease colloid osmotic pressure which is going to lead to intravascular volume depletion now this is going to make the kidneys think there's low blood pressure again so they're going to start secreting lots of renin leading to increase aldosterone production so the lab values is going to be exactly the same as primary it's going to be the same thing we're going to have increased serum sodium you're going to have hypertension going to have decrease serum potassium and we're going to have metabolic alkalosis so the only way really to differentiate between primary and secondary it's going to be these two in primary we're going to have increase all dot strong and the negative feedback is going to cause decreasing runnin in secondary we're going to have increased rainin production which is going to lead to eventually aldosterone production so both of these going to be high in the secondary cause so our best initial test is to measure the ratio of renin to aldosterone if renin is high then it's going to be secondary if running is low then it's going to be primary and if we're still not sure we can do the most accurate test which is to sample the venous blood draining the adrenal glands which will show high aldosterone levels now the next thing is how would we treat these patients if it's a unilateral tumor we can simply remove the tumor by laparoscopy and the patient will do just fine since his other adrenal gland will compensate and if we have a bilateral tumor or a secondary cause we can use sperner lactone which is an aldosterone antagonist that will interfere with binding of aldosterone to its receptors therefore preventing its actions we can also use it on patients with unilateral tumors we don't want to do laparoscopy thank you guys for watching this lecture please make sure to subscribe rate and comment you can also visit our website at medical - institution comm for many more lectures I wish you guys all the best

Channel: Daily Med Ed

Views: 57,756

Keywords: What is Conn's syndrome, What is Conns syndrome, what is Hyperaldosteronism, What is primary hyperaldosteronism, What is Secondary Hyperaldosteronism, Secondary Hyperaldosteronism, caues of conns syndrome, Endocrine system, endocrinology, RAAS, renin angiotensin aldosterone system, renin angiotensin aldosterone, adrenal gland, Pituitary gland, endocrinologist, endocrine disease, medical institution, USMLE, Primary Aldosteronism, COMLEX, NCLEX, Osmosis, Khan Academy, Hypokalemia

Id: 7btgrDHnR4s

Length: 8min 5sec (485 seconds)

Published: Sat Aug 03 2013