Question

A 56 year old woman was admitted to hospital due to complaints of headache, dzziness, vomiting and foot paralysis. A few days before admission, she had developed severe abdominal pain and vomiting Her blood pressure was 110/70 mmHg and pulse rate, 84 beats/min. Neurological examination showed no abnormal findings. Proximal muscle weakness was noted in the upper and lower limbs. There was no history of tetany, and Chvostek's sign and Trousseau's sign were negative. On presentatien: Reя1t Reference range 140-mall (135-145 mmol.) 170 mol L (3.6-5.0 mmol L) 35olL (2.13-25 mmol L) 029 mmol L (0.87-1.45 mmol L) 036 mmo (0.63-1.0 mmol L) 5.0 mmeL 2.5-7.0 mmol L) Total Balirubin AST 74 UL 92 U 95 UL 244 UL (30 UL) 637 UL 100-225 U/L) (045 U/L) ReseltReference range 99 mh1し (40-220 mmol/L) 254 mmoliday (25-125 Chloride 124 day 10-250 Calcium Creatinine 4472 mgiday 00-2000mg day) Blood Gas analysis: Resalt Reference range 7.35-745) 59 KPa 46-6.0 KPa) (10.7-14.6 KPa) 95 KPa 41.6 422-26 mmol/L)) mm ReultRefereace range 3.08 pmol L 1.3-13.7 pmol/L Cortisol Aldosterone 52molL Plasma rennin 54.9-188 pmelL 20g L.0-3.8 122 μ1mL 0.5-5.0 μUmL 3,0㎛oL 2 2.99.8.9 μmoL Critically evaluate the patient on presentation and on the basis of these findings discuss the fundamental problem present. In your answer discuss how the clinical history and the biochernical results aided your evaluation of the diagnosis. (100)

Answer 1

The fundamental problem of this patient is Conn's syndrome or hyperaldosteronism which is caused by too much of aldosterone secretion by the adrenal glands which can lead to lowered potassium or hypokalemia and increased hydrogen ion excretion or alkalosis .

Patient presents dizziness and feet paralysis which is a sign of hypokalemia

Patient complains of abdominal pain and vomiting and has an elevated liver enzymes and blood gas value shows pH of 7.6 which suggests that patient has metabolic alkalosis

Patient has an aldosterone level and renin activity which is elevated shows classical signs of hyperaldosteronism.

Thus the clinical presentation of vomiting dizziness paralysis and abdominal pain along with the biochemical findings of low potassium,metabolic alkalosis ,deranged liver enzymes elevated aldosterone level aided in diagnosing as Conn's syndrome.