Monday, 11 January 2010

Conn's Syndrome in pregnancy

In pregnancy there is physiological up regulation of renin-angiotension-aldosterone system.

A powerpoint explaining Conn's syndrome

Image explaining Renin-Angiotensin-Aldosterone cascade


Aeitiology
(I)Adrenal adenoma(60-80%)
(II)Adrenal hyperplasia(20-40%)
(III)Adrenal carcinoma rare

Clinical features
(I) Hypertension
(II)Muscle weakness

Investigation
(I)hypokalaemia
(II)radioactive selenium cholesterol test should be delayed until after delivery.
(III)suppressed renin activity
(IV) increased plasma aldosterone
(V)MRI of abdomen




Treatment
Multidisciplinary care involving Obstetrician,Endocrinologist and Physicians.
Hypertension should be controlled by anti hypertensives (labetolol,methyldopa,nifidipine)

Hypokalaemia managed by
(A) Potassium supplementation
(B)Potassium sparing diuretics Amelioride is preferred over spironolactone because of anti androgenic property of the latter that could lead to feminizing a male fetus.


Surgery is effective in adrenal adenoma or carcinoma but the value is limited in adrenal hyperplasia.Surgery could be postponed until after delivery.If surgery is indicated for



Labour
(i) Fluid & electrolyte balance should be maintained.





References
(I) Pituitary and adrenal disorders complicating pregnancy:Chandraharan, Edwin; Arulkumaran, Sabaratnam

Current Opinion in Obstetrics and Gynecology:April 2003 - Volume 15 - Issue 2 - pp 101-107

(2)Nelson-Piercy C. Handbook of obstetric medicine. Taylor & Francis; 2002.

(3)Swiet MD. Medical disorders in obstetric practice. Wiley-Blackwell; 2002.
(4)Laparoscopic treatment of primary hyperaldosteronism in a pregnant patient
(5)Primary aldosteronism in pregnancy.Matsumoto J, Miyake H, Isozaki T, Koshino T, Araki T.J Nippon Med Sch. 2000 Aug;67(4):275-9