Conn Disease - Causes, Symptoms, Diagnosis, and Treatment

What Is Conn Disease?

Conn disease, also known as primary aldosteronism, is a rare disorder of the adrenal glands characterized by the overproduction of the hormone aldosterone from the glands. Aldosterone is responsible for regulating the sodium and potassium levels in the blood. Therefore, too much of this hormone can cause low potassium levels and high blood pressure. The adrenal glands are two small endocrine glands nestled on each kidney, and these glands are triangular and about half-inch in height. The adrenal gland is divided into two parts, the adrenal medulla and the adrenal cortex. The adrenal medulla produces adrenaline, and the adrenal cortex produces steroid hormones like cortisone and aldosterone. In addition, aldosterone stimulates sodium reabsorption back into the blood and potassium excretion into the urine. It also causes water reabsorption into the blood vessels.

What Causes Conn Disease?

Conn disease mainly occurs sporadically, but it can be inherited (passed down from parents to offspring) in rare cases.

• Conn disease can be caused due to adrenal hyperactivity in either one adrenal gland (unilateral disease) or both adrenal glands (bilateral disorder).

• Unilateral adrenal hyperactivity is primarily due to a benign adrenal tumor known as an adenoma. And less commonly, it may occur due to adrenal hyperplasia or adrenal cancer.

• Bilateral disease is usually caused by bilateral adrenal hyperplasia (hyperactivity of the whole gland).

• In rare cases, it can be hereditary. However, Conn disease is not hereditary, but it can occur due to a hereditary underlying cause.

• Several other reasons may lead to excess aldosterone production like; fluid loss, kidney artery narrowing, shock, pregnancy , liver diseases, heart failure, kidney tumors, etc. However, overproduction of aldosterone due to any other reason apart from any problem in the adrenal gland is called “secondary hyperaldosteronism.”

Who Is Affected by Conn Disease?

• Conn syndrome is a rare disorder occurring sporadically in individuals. However, anyone can be affected by this disease.

• Women are more affected by this disorder than men.

• This disorder mainly occurs between the age of 30 to 50 years.

• Conn disease is the most common cause of secondary hypertension; 6 % to 20 % of patients with resistant hypertension and type 2 diabetes are affected.

What Are the Symptoms of Conn Disease?

Following are the signs and symptoms of Conn disease:

1. The most common symptom of Conn disease is hypertension, and it is often the only clinical sign seen in patients with this disease.

2. Hypokalemia (low potassium level) is also seen in patients with Conn disease.

3. Muscle weakness.

4. Headaches.

5. Increases thirst.

6. Fatigue.

7. Frequent urination.

8. Visual disturbance.

9. Cramps and muscle twitches.

10. Pins and needles feeling.

Conn Disease vs. Addisons Disease and Cushings Disease?

Mentioned below are a few other endocrine disorders compared to Conn disease.

• Secondary Hyperaldosteronism: There is an increased level aldosterone and renin in the body and the symptoms associated are increased hypertension (hypertension), decreased potassium concentration in the blood (hypokalemia), and alkalosis (body fluid’s have excess base).

• Cushings Disease: There is an increased cortisol level in the body or decreased adrenocorticotropic hormone levels in the body. Symptoms associated with Cushing’s syndrome are excessive weight gain, easy bruising, muscle weakness, increased blood pressure, diabetes, etc.

• Addisons Disease: There is a decrease in the levels of aldosterone and cortisol hormones. The symptoms associated are decreased blood sugar level (hypoglycemia), increased potassium concentration in blood (hyperkalemia), decreased sodium concentration (hyponatremia), and increased urea level in the body.

How Is Conn Disease Diagnosed?

The following diagnostic tests are done to confirm a case of Conn disease:

1. Blood Examinations:

Blood samples are collected and evaluated for increased aldosterone and renin (a hormone produced by the kidneys). These samples are collected in the morning and sent to the laboratory for investigation. In the case of Conn disease, the aldosterone level will be increased. If the levels of aldosterone are elevated, then a few other tests are done; in these tests, the amount of aldosterone is tried to be lowered through medication, diet, or intravenous fluid. If the aldosterone level is still high and the renin level is low, the diagnosis of Conn disease is confirmed.

2. Urine Examination:

Urine samples are collected to check for high aldosterone and low potassium levels.

3. PAC: PRA Ratio:

PAC: PRA ratio is the ratio of the plasma aldosterone concentration (PAC) to plasma renin activity (PRA). A high PAC: PRA ratio suggests Conn disease.

4. Captopril Suppression Test:

Captopril is a drug used to treat hypertension, and in this blood test, the body’s response to Captopril is measured.

5. A 24- Hour Urinary Excretion of Aldosterone:

The patient undergoing this test is advised to eat a high-salt diet for five days, and then urine samples are collected for 24 hours. A high level of aldosterone in the urine will confirm the diagnosis.

6. Saline Suppression Test:

The patient is given salt solution through an intravenous route, and then blood samples are collected to check for aldosterone and renin levels. Diagnosis of Conn disease is confirmed if the aldosterone level remains high.

7. Computed Tomography Scan (CT scan) or Magnetic Resonance Imaging (MRI): After confirming Conn disease in a patient, the next step is to determine if the disorder is unilateral or bilateral because the treatment for both of these types is different. An imaging test like a CT scan or MRI can determine the presence of a tumor in either of the glands.

8. Selective Venous Sampling:

This test is done in older patients or in the case where there are either no tumors or tumors present on both glands. The doctor collects blood samples directly from the veins draining the adrenal glands to determine if they are making more aldosterone.

How Is Conn Disease Treated?

The treatment of Conn disease is primarily based on its underlying cause:

• In the case of a patient with a single benign tumor, surgical removal is advised. After successful adrenalectomy, about 95 % of the patients have reported significant improvement in their hypertension.

• For patients with bilateral hyperplasia, the treatment is done through medication. The drug of choice is called Aldosterone - antagonist (Spironolactone or Eplerenone). This blocks the effects of high Aldosterone.

• In addition, patients are also advised to maintain a low sodium diet, stop smoking, reduce alcohol intake, and exercise regularly.

What Are the Complications of Conn Disease?

If Conn disease is left treated, it can lead to uncontrolled hypertension, and it can cause the following complications:

1. Heart attacks.

2. Heart failures.

3. Strokes.

4. Kidney failures.

5. Temporary paralysis.

How to Naturally Cure Conn Disease?

Conn disease cannot be prevented or treated naturally. Antihypertensive drugs and sometimes surgical intervention are necessary to manage and treat the disease.

What Is the Prognosis of Conn Disease?

Conn disease can be easily managed with the help of medication. Surgical treatment of Conn disease also has an excellent prognosis; almost all patients recover rapidly and uneventfully after the surgery. High blood pressure is improved in about ninety patients out of every hundred patients.

Conclusion:

Conn disease, or primary hyperaldosteronism, is characterized by overproduction of the aldosterone hormone by the adrenal glands. Aldosterone is the hormone that regulates blood pressure by managing sodium and potassium levels. Conn disease can occur due to an adrenal tumor or bilateral adrenal hyperplasia. The disease almost always occurs sporadically, but it can be inherited in rare cases. The treatment of Conn disease is crucial because this condition can cause life-threatening complications like heart attack, heart failure, stroke, etc.