A patient with primary hyperaldosteronism (Conn's Syndrome) requires careful pre- and perioperative management to avoid complications. Occasionally the diagnosis may not be suspected prior to surgery. much to the surprise of the anesthesiologist.


Issues impacting anesthesia:

(1) hypokalemia, which is associated with depletion of the total body potassium stores

(2) metabolic alkalosis

(3) arterial hypertension, which may be resistant to therapy

(4) skeletal muscle abnormalities related to the hypokalemia, which may impact the use of muscle relaxants

(5) edema secondary to sodium retention

(6) ECG changes secondary to hypokalemia

(7) additional drop in potassium level following intraoperative hyperventilation or administration of insulin, or diuresis

(8) hypovolemia (may first present with orthostatic hypotension)

(9) presence of concurrent acromegaly, hyperparathyroidism and/or pheochromocytoma

(10) hypokalemic nephropathy with polyuria

(11) hypomagnesemia


Manipulation or removal of the adrenal glands may be associated with:

(1) transient drop in cortisol

(2) release of aldosterone

(3) release of epinephrine, especially if there is a concurrent pheochromocytoma


Drugs that can be helpful:

(1) spironolactone (aldosterone antagonist)

(2) potassium canrenoate (an aldosterone receptor antagonist)

(3) antihypertensive therapy

(4) cortisol infusion if manipulating the adrenal glands

(5) triamterene (a potassium sparing diuretic)


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