Conn Syndrome

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imtheman25

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How does Conn Syndrome (primary hyperaldo) cause hypertension if you have normal Na+ (via the aldo escape mechanism)? According to Goljan, htn is always assoc with increased Na+. Just had a Uworld question that stated a pt with hypertension due to conn syndrome has nL sodium, low potassium and high bicarb. I just dont get how you can have htn with normal sodium. Thanks!!

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Aldosterone causes reabsorption of sodium and water and increased excretion of potassium and hydrogen. The sodium is reabsorbed, but so is the water. While sodium is maintained at low levels by the escape mechanism, the patient is still hypervolemic to a large extent (sometimes 3 kg of retained water) from the reabsorbed water. This causes hypertension.
 
Aldosterone causes reabsorption of sodium and water and increased excretion of potassium and hydrogen. The sodium is reabsorbed, but so is the water. While sodium is maintained at low levels by the escape mechanism, the patient is still hypervolemic to a large extent (sometimes 3 kg of retained water) from the reabsorbed water. This causes hypertension.
Thanks but how is the patient hypervolemic if the sodium is normal? I thought that with the increased excretion of sodium, water almost always follows it.
 
Thanks but how is the patient hypervolemic if the sodium is normal? I thought that with the increased excretion of sodium, water almost always follows it.

The sodium is normal because you're absorbing water and sodium, it isn't an absolute value.
 
Thanks but how is the patient hypervolemic if the sodium is normal? I thought that with the increased excretion of sodium, water almost always follows it.

its like you have 10 and 10, the ratio is still 1. lets say with aldo, you absorb Na+ and water follows so now you have 15 and 15. The ratio is still 1 but the overall is increased which induces Hypertension even though sodium is normal via lab
 
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