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Conn's syndrome

Conn's syndrome is overproduction of the mineralocorticoid hormone aldosterone by the adrenal glands. Aldosterone causes sodium and water retention and potassium excretion in the kidneys, leading to arterial hypertension (high blood pressure). It is a rare but recognised cause of nonessential hypertension. It is named after Dr Jerome W. Conn (1907-1981), the American endocrinologist who first described the condition in 1955. It is the most common form of primary Hyperaldosteronism. more...

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Signs, symptoms and findings

Apart from high blood pressure, the symptoms may include muscle cramps and headaches (due to the low potassium), metabolic alkalosis (due to increased production of bicarbonate in the kidney). The high pH of the blood makes calcium less available to the tissues and causes symptoms of hypocalcemia (low calcium levels).

It can be mimicked by liquorice ingestion (glycyrrhizin) and Liddle syndrome.

Diagnosis

Measuring aldosterone alone is not considered adequate to diagnose Conn's syndrome. Rather, both renin and aldosteron are measured, and the ratio is diagnostic. Usually, renin levels are suppressed, leading to a very low renin-aldosterone ratio (<0.05). This test is confounded by antihypertensive drugs, which have to be stopped up to 6 weeks.

If there is biochemic proof of hyperaldosteronism, CT scanning can confirm the presence of an adrenal adenoma.

Causes

The syndrome is due to:

  • adenoma (benign tumor, 50-60%)
  • hyperplasia of the adrenal gland (40-50%)
  • rare forms

Therapy

Surgical removal of the offending adrenal (adrenalectomy) takes away the source of the excess hormones. Meanwhile, the blood pressure can be controlled with spironolactone (a diuretic that counteracts the actions of aldosterone) and other antihypertensives.

Reference

  • Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians 1955;68:215-31; discussion, 231-3. PMID 13299331.

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Conn's Current Therapy 1997. - book reviews
From American Family Physician, 8/1/97 by Mary E. Jewell

Saunders has again met the needs of primary care physicians with Conn's Current Therapy 1997, now in its 49th edition. It is designed "to provide the busy practitioner with up-to-date information on recent advances in medicine in a concise and easy to read manner." This goal has been met with practical and brief but thorough articles on most conditions a family physician will see. The book covers pediatric, surgical, obstetric and gynecologic subjects as well as subjects in general medicine. It includes therapies that are not yet approved by the FDA. Having this text available is like having several subspecialists on hand to answer questions.

In every chapter, a specialist in the subject area explains how he or she personally handles the condition being discussed. This might create a situation in which an author's prejudice could lead him or her to leave out information. New authors are used each year, at least, making Conn's Current Therapy 1997 a completely new book. Thirty topics are covered by international authors. Topics such as cholera, leishmaniasis, leprosy and tetanus make this an appropriate text for physicians practicing in developing countries as well.

This is not a standard medical textbook but is designed to be used as a treatment reference. Consequently, there are no pictures, few graphs or diagrams, and the articles are not referenced. On the other hand, the index is excellent and the book contains a table of reference values in both conventional and Sl units.

Six new topics were added this year: chronic fatigue syndrome, high altitude sickness, giardiasis, erectile dysfunction, attention-deficit hyperactivity disorder and hypertrophic cardiomyopathy. Unfortunately, the section on ADHD only briefly mentions the condition in adults, a group which has been increasingly recognized. as also having attention problems.

The sections on high altitude sickness and hypertrophic cardiomyopathy are more technical than an average article in the text. The sections on chronic fatigue syndrome, giardiasis and erectile dysfunction give good overviews.

The 1997 edition includes significant updates of information from the 1995 edition. In 1995, only a small paragraph was devoted to the role of Helicobacter pylori in peptic ulcer disease, while in the 1997 edition, almost twopages cover the diagnosis and treatment of H. pylori. The diabetes chapter discusses the roles of newer agents such as acarbose and metformin. The affective disorder section covers the newer antidepressants well. The HIV chapter includes the use of 3TC, d4t and protease inhibitors. The reader can be assured of current information. In many chapters, up-and-coming therapies are discussed so that the reader can be aware of new developments before the next year's edition is published.

Conn's Current Therapy 1997 has helpful chapters on patients' symptoms unrelated to specific conditions, such as pain, cough and pruritus. The acute poisoning chapter has almost 50 pages and covers the information needed to treat most poisonings. Considering how much psychiatric illness is seen by family physicians, that section should be expanded in the discussions of the various anxiety disorders and eating disorders.

Having this text is much like having all the current journal articles available in one volume, making it convenient to own. Saunders makes this text easy to obtain by offering a subscription enabling one to receive the book yearly upon publication. The book can be reviewed for 30 days and returned at no risk. Few copies will probably be returned. Not only will family physicians find this book a valuable tool for quick information, but also this book could help those in other specialties who often find themselves needing to understand problems outside their field.

COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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