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Conn’s Syndrome

Introduction

 Conn’s syndrome, also known as primary hyperaldosteronism, is fairly rare condition that is caused by an overproduction of the aldosterone hormone within the body. This specific hormone plays a role in many physiological systems throughout the body, but its main function is to regulate salt and water. Aldosterone is the final part of electrolyte and water absorption within the nephron before excretion in the urine. Elevated levels of aldosterone results in a reduction of plasma potassium and retention of sodium. This ultimately causes an increase in blood volume within the vasculature, thus increasing blood pressure.

Primary hyperaldosteronism is the most common cause of secondary hypertension and occurs in about 6% to 20% of adult hypertensive patients. It is even more prevalent in patients with resistant hypertension. The etiology of Conn’s syndrome may be idiopathic or secondary to adrenal hyperplasia, adrenal adenoma, aldosterone-secreting adrenal carcinoma, or familial hyperaldosteronism. There have been various genetic alterations that have been linked to familial forms of the disease, including abnormalities in CYP11B2 and CYP11B1 genes, chromosome 7p22, and mutations in the KCNJ5, G151E, and G151R genes. Other genes that have been related to the condition include ATP1A, ATP2B3, CACNAID, and NR3C2. Most of these alterations result in calcium influx and membrane depolarization resulting in aldosterone hypersecretion.1

Clinical Presentation

Most patients with Conn’s syndrome often present with having higher than normal blood pressure. Other symptoms that a patient with this disorder might have are related to the abnormal electrolyte levels within the blood due to excessive aldosterone. These symptoms include lack of muscle strength, headache, increased thirst, numbing feeling in the extremities, muscle cramps, eyesight issues, palpitations, and frequent urinary voiding.4

The complications related to this disorder are mainly cardiovascular related. This is due to patients having greater stress and pressure on the left ventricle, as well as decreased left ventricular function when compared to individuals without the disease. The most severe complications that arise from Conn’s syndrome are stroke, atrial fibrillation, and myocardial infarction. Other risks that this disease places on the patient include renal dysfunction and metabolic syndrome. Although some patients with primary aldosteronism may be absent from the above complications or symptoms, primary hyperaldosteronism can put great stress on an individual and can be extremely problematic in certain disease states. For example, if a patient already has hypertension, this condition may make it even more difficult to treat. Also, in patients with heart failure, the excessive aldosterone can place significant morbidity and possible mortality on the patient; elevated aldosterone levels can increase bodily fluid, which can cause a great amount of symptom burden in this patient population. It is important to identify the condition as soon as possible in order to reduce morbidity and mortality of the affected patient.1,2,4

Diagnosis

The Endocrine Society recommends the screening of patients for primary hyperaldosteronism in the following patient populations: Patients with hypertension on triple-drug therapy and diuretic-induced hypokalemia; patients with hypertension and adrenal incidentaloma; hypertension with a family history of the early-onset cerebral vascular accident; or patients with hypertension and first-degree relatives with confirmed primary hyperaldosteronism. This is mainly due to the fact that an excessive amount of aldosterone has the possibility of playing an important role of the listed disease states.1,2

Besides the patient populations mentioned above, one should suspect Conn’s syndrome if a patient presents with hypertension at an early age with hypokalemia and poorly controlled blood pressure with adequate medical treatment. After suspicion is made, the next step is to obtain a morning plasma aldosterone and renin ratio. If the ratio is higher than 20:1, then an excess of aldosterone can be attributed to the adrenal gland as the primary source. After the ratio has been determined, a provider may use any of the four following tests to confirm diagnosis (usually use at least two): oral sodium loading, saline infusion, fludrocortisone suppression, captopril challenge. All of these confirmatory tests should suppress aldosterone, however, in a patient with Conn’s syndrome, there will be a lack of aldosterone suppression. A CT scan is then undertaken in order to confirm that an adrenocortical carcinoma is not present. Adrenal venous sampling is then recommended.1,2

Treatment

The treatment for primary hyperaldosteronism includes laparoscopic resection to repair adenomas on the adrenal gland. This procedure usually resolves the associated hypokalemia, but hypertension still remains in up to 65% of patients’ post-surgery. In patients with bilateral hyperplasia, the treatment usually consists of diuretics, which help manage fluid buildup in the body. Idiopathic or secondary hyperaldosteronism is often treated with mineralocorticoid antagonists, such as spironolactone or eplerenone. Other potassium-sparing diuretics like amiloride can also be used.  Conn’s syndrome is related to adrenal inefficiency & if you take proper supplement for adrenal then it will be recovered successfully. To learn more about adrenal & cortisol supplement, kindly visit this link: natural approaches to adrenal & cortisol health

 References

 1.     Cobb A, Aeddula NR. Primary Hyperaldosteronism. [Updated 2020 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539779/

2.     Parmar MS, Singh S. Conn Syndrome. [Updated 2019 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459197/

3.     Schirpenbach C, Segmiller F, Diederich S, et al. The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry. Dtsch Arztebl Int. 2009;106(18):305‐311. doi:10.3238/arztebl.2009.0305

4.     What is Conn's Syndrome? Conn's Syndrome: Symptoms, Diagnosis & Treatment - Urology Care Foundation. https://www.urologyhealth.org/urologic-conditions/conns-syndrome#:~:text=Conn's syndrome is a rare,leads to high blood pressure. Accessed June 12, 2020.

SEE ALSO

Addison’s Disease

Cushing’s Syndrome

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Graves’ Disease

Introduction

Graves’ disease is a syndrome that consists of an enlarged and overactive thyroid gland that causes hyperthyroidism. This disease has an autoimmune etiology that results from complex interactions between environment and genetic factors. Essentially, a person with Graves’ disease immune system attacks the thyroid gland and causes it to produce more thyroid hormone than the body requires. The thyroid hormone is responsible for many physiological aspects within the body and how the body uses energy. The thyroid plays a role in nearly every organ system in the body. This makes it extremely problematic if the thyroid is not functioning properly, which is the circumstance in Graves’ Disease. If left untreated, this condition can cause significant issues with the heart, muscles, bones, eyes, skin, menstrual cycle, and fertility.1

 With an annual incidence of 20 to 50 cases per 100,000 people, Graves’ disease is the most common cause of hyperthyroidism.2 It usually affects people aged 30 to 50 years old but has the possibility of occurring at any age. Women are seven to eight times more likely to develop Graves’ disease when compared to men. Besides gender, a person is at increased risk if family members have the disease. Having other autoimmune conditions is another risk factor for developing Graves’ disease, such as rheumatoid arthritis, lupus, celiac disease, vitiligo, type 1 diabetes mellitus, Addison’s disease, and pernicious anemia. The most prevalent complications of Graves’ disease include ophthalmopathy, heart-related problems, osteoporosis, and localized dermopathy and acropachy1; Graves’ disease-associated ophthalmopathy is the most common with 16 cases per 100,000 women and 3 cases per 100,000 men.2

 Clinical Presentation

The manifestations of Graves’ disease ultimately depends on the age of the patient, as well as the severity and duration of hyperthyroidism. Possible symptoms include weight loss, palpitations, tremor, dyspnea, loss of libido, neck fullness, thirst and polyuria, pruritus, nervousness, hyperactivity, anxiety, insomnia, muscle weakness, increased sweating, and eye symptoms. Weight loss, fatigue, heat intolerance, tremor, and palpitations are the most frequent symptoms, occurring in over 50% of patients. The symptoms of weight loss, cardiac manifestations, and decreased appetite are more common in the elderly population. Physical signs of hyperthyroidism due to Graves’ disease include tachycardia, atrial fibrillation, hypertension, cardiac failure, warm skin, hair loss, palpable goiter and mood changes.2

 These manifestations of Graves’ disease occur due to abnormalities within the immune system. In Graves’ disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) that interacts with thyroid cells similar to the thyroid-stimulating hormone (TSH). The thyroid gland misinterprets the immunoglobulin as TSH, which causes the thyroid to make too much thyroid hormone. This is the main physiological mechanism behind the disease, although reasons to why this occurs is still not fully understood. Certain alterations in specific genes have been identified conferring susceptibility to the development of TSI. These include genes encoding thyroglobulin, thyrotropin receptor, HLA-DRβ-Arg74, the protein tyrosine phosphatase nonreceptor type 22 (PTPN22), cytotoxic T-lymphocyte–associated antigen 4 (CTLA4), CD25, and CD40.2

Diagnosis

Suspicion of Graves’ disease is based upon a patient’s symptoms and physical exam. As mentioned before, all patients with Graves’ disease will present with hyperthyroidism, but it can be difficult to link the cause of hyperthyroidism to Graves’ disease. Some common signs that hyperthyroidism is linked to the disease includes an enlarged thyroid, signs of Graves’ eye disease, or a history of other family members with thyroid or autoimmune disorders. If a diagnosis is still uncertain, blood tests and imaging tests can be utilized to confirm that Graves’ disease is the cause. Blood tests can detect TSI within the body, however, this is not the case for every patient with the disease. Imaging tests use safe doses of radioactive iodine in order to determine the activity of the thyroid. Normally, iodine is taken up by the thyroid from the bloodstream in order to make thyroid hormones; radioactive iodine is utilized the same way and the amount collected by the thyroid is measured. If the thyroid collects a large amount of the iodine, it may be an indicator of Graves’ disease. Another type of imaging test used is a thyroid scan. This test shows providers how iodine is being distributed in the thyroid gland. If the entire thyroid is involved and the iodine is being dispersed throughout the gland, this is an indicator of Graves’ disease. With other causes of hyperthyroidism, the iodine shows up in a more condensed and different pattern.1

 Treatment

 The following discussion on the treatment of Graves’ disease is limited to adult patients due to special consideration in younger individuals. Remission is possible and can happen spontaneously to a small proportion of patients, but data on the stability of remission is currently unavailable. The first step in the treatment is smoking cessation in patients who are current smokers. For patients who are active smokers or former smokers, the efficacy of medical treatment is significantly decreased; patients need to understand the importance of this aspect of treatment. Patients have a variety of treatment options in order to manage their Graves’ disease. This includes medications, radioiodine therapy, or thyroid therapy. Graves disease is a disease related to thyroid, so treat grave disease you need to take thyroid supplement. To learn more about thyroid supplement, kindly go through this link: - Thyroid System Overview

 The medications that are used in Graves’ disease include beta blockers and antithyroid medicines. Beta blockers do not directly alter the disease, rather, they act quickly to relieve many of the symptoms of hyperthyroidism such as nervousness, tachycardia, and trembling. The antithyroid medications used include methimazole and propylthiouracil. These medications offer the patient the simplest option to treat their associated hyperthyroidism. These medications inhibit thyroid peroxidase, thus block the synthesis of TSH. Methimazole is usually the preferred option in most patients, while propylthiouracil is the preferred option in women who are pregnant. It may take up to several weeks for antithyroid medications to move thyroid hormone levels to normal range and the average treatment time is about 12 to 18 months. For patients who do not want radioiodine therapy or surgery to treat their Graves’ disease, treatment may be extended for years.1

Radioiodine therapy consists of taking iodine-131 (I-131) by mouth at higher doses than doses used for imaging tests. I-131 gradually destroys the cells of the thyroid that produce TSH. In most cases, patients later develop hypothyroidism due to cells being destroyed by I-131. Patients usually see their hormone levels in normal range after 1 radioiodine treatment, but if needed, more than one treatment may be warranted. Thyroid surgery is the least common method for managing Graves’ disease. This surgery consists of total removal of the thyroid gland. This option is generally only preferred in patients with large goiters or pregnant women who are allergic or have side effects to antithyroid medications.1

 Conclusion

 Graves’ disease is an autoimmune disorder which is the most common cause of hyperthyroidism in the United States. Symptoms that occur due to the disease are of wide variety and are associated with increased stimulation of the thyroid gland by the immune system. In order to confirm that Graves’ disease is the cause of a patient’s hyperthyroidism, symptoms and a physical exam as well as blood and imaging tests are utilized. The treatment options for patients include antithyroid medications, radioactive iodine, and thyroid surgery; with antithyroid medications being the most common and convenient. If left untreated, this disease has the potential be detrimental and significantly affect an individual’s quality of life.

References

1.     “Graves' Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, NIH, 1 Sept. 2017, www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease#:~:text=Graves' disease is an autoimmune,the front of your neck.

2.     Smith TJ, Hegedüs L. Graves' Disease. N Engl J Med. 2016;375(16):1552‐1565. doi:10.1056/NEJMra1510030

SEE ALSO

Hashimoto Disease

Thyroid Cancer

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Inguinal Hernia

Introduction

 An inguinal hernia is the most common type of hernia and specifically involves the groin area of both males and females. This type of hernia can arise from either of the two inguinal canals in the lower abdominal region; one of the left side of the groin and one on the right side. Inguinal hernias can be further classified to either direct or indirect. Direct inguinal hernias protrude medial to the inferior epigastric vessels. This is most commonly due to the result of a weakness in the floor of the inguinal canal caused by age-related stress. Indirect inguinal hernias protrude lateral to the inferior epigastric vessels. This is most commonly congenital related and is due to increases in intra-abdominal pressure in correlation with decreased muscle tone and other connective tissue abnormalities. Both types of inguinal hernias usually contain fat or part of the small intestine, and possibly part of the reproductive system in females. When an inguinal hernia is present, part of the peritoneum protrudes through the lower abdominal wall and forms a sac around the hernia. It is more common to occur on the right side than on the left, but it is possible for some people who develop an inguinal hernia on one side to develop or have a hernia on the other side as well. The prevalence of inguinal hernias is more common in males than females, but both sexes are prone to the development of this specific type of hernia. Most inguinal hernias do not cause significant harm to the patient and can actually be left untreated, but in rare cases they can lead to life threatening complications.

 Diagnosis

 In order to accurately diagnose an inguinal hernia, a patient’s medical history, symptoms, physical exam, and possibly imaging tests will need to be obtained. Patients who are at increased risk for developing an inguinal hernia include having a history of hernia or prior hernia repair, older age, male sex, Caucasian race, chronic cough, chronic constipation, abdominal wall injury, an active smoker, and having a family history of hernia. Symptoms of an inguinal hernia include a bulge in the groin, a bulge in the scrotum in a male, and feelings of discomfort, pain, heaviness, or burning in the groin. These symptoms may become worse if one is straining themselves, coughing, or standing for a long period of time. Patients need to seek medical attention immediately if symptoms of a stuck or strangulated hernia develop; which includes a hernia bulge that is suddenly larger than before, fever, redness in the area of the hernia, sudden or severe pain, or symptoms of intestinal obstruction. The physical exam will consist of examining the abdomen area. The patient may need to stand, cough, or strain while having a physical exam performed on them in order to check for bulges caused by the hernia. Common imaging tests that are used in order to further discriminate the hernia include an ultrasound, CT scan, or MRI.4,5

 Treatment

 Most patients who present with an inguinal hernia, whether direct or indirect, will need surgery in order to correctly repair the hernia. The different types of surgery include open and laparoscopic hernia surgeries. The type of surgery will ultimately depend on many clinical factors, including the size of hernia, age, health, and medical history. There is also the option of watchful waiting. Men with inguinal hernias that are mild and cause few or no symptoms may be able to safely delay surgery and use the watchful waiting approach as an alternative,3 although in one study roughly 70% of men who delayed surgery developed new or increasing symptom burden and required surgery within 5 years.2

 Open hernia surgery consists of a surgeon making a cut into the patients groin to view and repair the hernia. After the hernia is repaired, stitches and a piece of mesh are used to close the abdominal wall and add support. Laparoscopic hernia surgery is similar to open hernia surgery with the exception of several smaller cuts being made at the groin to view and repair the hernia, rather than one large cut.4,5 In one study that evaluated recurrence rates over a 20 year follow-up for open surgery versus laparoscopic surgery demonstrated a significantly lower recurrence rate of inguinal hernia in patients who underwent open hernia surgery rather than laparoscopic hernia surgery.1 These results do have limitations as the study was conducted in the mid 1990’s and technology and expertise has improved over time. Although both surgeries are effective, they do pose risks for the patient. These risks include urinary retention, infection, swelling in the surgical region, chronic pain, and hernia recurrence.5 Overall, treatment options include watchful waiting or surgery. Both patients and providers need to be aware of the risks and benefits of surgery intervention, as well as individual patient factors, in order to make an appropriate clinical decision.

 Natural and Non-Pharmacological Approaches

 Most natural or non-pharmacologic therapies for inguinal hernias are directed toward chronic post-operative inguinal pain management and there are minimal studies evaluating these approaches in this setting. Although efficacy and safety have not been established, people have the potential to benefit from physical therapy, acupuncture, psychotherapy, hypnosis, and biofeedback. These therapies are usually used adjunctively to pain modulating pharmacotherapy.4 To learn more about non-pharmacological approaches to aiding hernia, please visit the following link: natural approaches to aid hernia.  

 References

 1.      Barbaro A, Kanhere H, Bessell J, Maddern GJ. Laparoscopic extraperitoneal repair versus open inguinal hernia repair: 20-year follow-up of a randomized controlled trial. Hernia. 2017;21(5):723‐727. doi:10.1007/s10029-017-1642-7

2.      Fitzgibbons RJ Jr, Ramanan B, Arya S, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258(3):508‐515. doi:10.1097/SLA.0b013e3182a19725

3.      Goede B, Wijsmuller AR, van Ramshorst GH, et al. Watchful Waiting Versus Surgery of Mildly Symptomatic or Asymptomatic Inguinal Hernia in Men Aged 50 Years and Older: A Randomized Controlled Trial. Ann Surg. 2018;267(1):42‐49. doi:10.1097/SLA.0000000000002243

4.      HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1‐165. doi:10.1007/s10029-017-1668-x

5.      Inguinal Hernia. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia. Published September 1, 2019. Accessed May 26, 2020.

6.      Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165(10):1154‐1161. doi:10.1093/aje/kwm011

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Thyroid System Overview

Unfortunately, diseases involving the thyroid are all too common, affecting nearly 20 million Americans. Because these diseases often cause a hormone imbalance, they can lead to a variety of negative outcomes throughout the body. In this article, we will guide you towards the overview of the thyroid system.

Thyroid System Overview or T4 levels

T4, or Thyroxine or Thyroid System, is one of the primary hormones produced by the thyroid gland. T4 levels or Thyroid system play a critical role in many bodily functions, including metabolism, temperature control, and weight gain. A common method of diagnosing thyroid disease is by measuring T4 levels in the blood and comparing them to a healthy reference range.

In Graves Disease, the body produces antibodies that target the thyroid gland, causing it to produce excess thyroid hormones. Graves Disease symptoms are like hyperthyroidism symptoms, which include weight loss, difficulty sleeping, and tremor. Other Graves Disease symptoms are bulging eyes, goiter development, and anxiety. To recover from thyroid related diseases, you can check our products from our website by clicking on below link: https://natures-reveal.com/

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Natural Approaches to Digestive Dysfunction

The severity of these problems can also vary. They can span from mild problems like constipation to more serious ones that require hiatal hernia natural treatment.

Hernias come in many forms depending on their location and severity. All hernias, however, are similar in how they develop. Thus, it is an unnatural bulging of an organ or tissue through a weak spot in the muscle. The most common type is the hiatal hernia.

Some natural treatments help with hernias, however, they can also help with other health problems. Stopping smoking and being at a healthy weight are always recommended. None-the-less, they are important for maintaining a healthy body.   Therefore, this makes it an important topic.  In conclusion, hernias, constipation, and diarrhea are some of the most frequently seen stomach problems. It is important to become familiar with these problems.

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Muscular Dysfunction- Causes & Remedies

Muscles are the driving force behind everything the body does. They protect our organs, maintain our body temperature and make movement possible. So, when there is something wrong with our muscles, it can reduce our quality of life.

It is important to reduce the amount of pressure on the stomach. You can do this by carefully lifting proper heavy objects, eating smaller meals, and avoiding straining on the toilet. Increasing the amount of water and fiber in your diet will help to prevent constipation. This can also help to reduce your risk of hernias. You can manage heartburn by not eating acidic or spicy foods. Also, not lying down right after eating a large meal. The most effective natural remedies for hiatal hernia is to keep a healthy body weight. Being overweight can place pressure on the stomach. This can increse your risk for constipation.

Because of how important muscles are for everyday life, treating muscle pain is important. Luckily, there are many strategies to maintain healthy muscles and help treat pain when it happens.

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Gastrointestinal Dysfunctions – Symtoms & Causes

There are many issues relating to the stomach. These can range widely in presentation and how severe it is. You can use non-drug strategies or natural hernia remedies to manage or even prevent stomach issues.

There are many natural hernia remedies that can help with treating and preventing hernias. Things like lifting heavy objects properly and warming up before exercise can be helpful. This can help to prevent injuries and muscle weakening. You should complete 20-30 minutes of exercise a day. Yoga can improve strength and flexibility. This it cab be a good option to prevent hernias.