By: Damian Casillas Glenda Flores Isabella Hudson Kayla Mercer

1. Case Report “Hyper Aldo” By: Damian Casillas Glenda Flores Isabella Hudson Kayla Mercer

2. Patient: Aldo Conn 42 year old male showed up at Masonic Health Care Center reporting symptoms of headache, extreme fatigue, muscle cramps and weaknesses, and vision problems. Reported seeing symptoms about 3 weeks after his son had died in a car accident.

3. Aldo Conn Patient is a college English professor at ECSU. Reported the loss of his son in a car crash about two weeks ago. Reported that he has been under a lot of stress related to his relationship problems between him and his wife.

4. Exam at Masonic Health Care Center Patient was seen by the center’s Internist. History and physical exam taken. Medical history reveals that he had pneumonia at age 23. Penicillin allergy Reports recent thoughts of suicide Patient Meds= Benadryl (common seasonal allergies)

5. Internist Physician who specializes in the diagnosis and medical treatments of adults.. Responsible for all adult medicine (internal medicine) Minimum of 7 years of med. school and postgraduate training Diagnose and provide non-surgical treatment for diseases and injuris of internal organ systems.

6. Exam Vital signs HEENT: eye exam reveals sclera is red and inflamed Palpation revealed no abnormalities CN Exam: WNL Reflexes: normal Reports his previous thoughts of suicide to the internist

7. Exam Dx: Depression Rx: Anti-Depressents and psychotherapy every other day

8. Patient in Crisis Patient reports 2 weeks later that he was temporarily paralyzed while trying to take his daily morning walk. He claims he remained paralyzed for only a short time. Reported to his wife and later that night she drove him to the hospital.

9. Patient admitted into hospital Patient was admitted to Bradley Memorial Patient seen by the Cardiologist

10. Cardiologist job description A Cardiologists specialize in the diagnosis, treatment and intervention of diseases of the heart and cardiovascular system. Most of them work in small private offices or clinics, often assisted by a small staff of nurses and other administrative personnel. The cardiologist also needs to be an expert on diet and exercise.

11. Duties of Cardiologist Provide treatment to patients suffering from heart problems Maintain detailed reports on each patient and also a report on their progress Give medicines that are compatible with the other medicines the patient is taking

12. Exam Vital Signs: Normal HEENT: Noncontributory CPK Blood Test: High (abnormal) HPI:The patient is a 42 year old white male three weeks status post myocardial infarction with no complications. FH:Father died of AMI age 51 yrMother alive and well age 70 yr No sisters or brothers SH:Married, two children, English professor No smoking or significant alcohol history Lungs: clear to auscultation CV: Normal sinus rhythm, rate 84 bpm Extremities: no edema

13. Exam Dx: Post myocardial infarction with no complications. Rx: Referred to the cardiac rehabilitation program for an exercise routine and lifestyle modification in order to reduce routine and lifestyle modification in order to reduce his risk for a second MI.

14. Patient in Need Patient notices symptoms reoccurring more frequently and more severe Wife notices him suffering and convinces him to go admit into the hospital Patient admits to Joshlin Diabetes Center at NBGH

15. Joshlin Diabetes Center at The Hospital of Central Connecticut Seen by the hospital’s Endocrinologist. Reports to the Endocrinologist of his previous visits to the health center and Bradley.

16. Endocrinologist Specialty training, takes about ten to twelve years of training Trained to diagnose diseases that affect your gland Involves the diagnostics of a wide variety of symptoms and the long term management of disorders having to do with the endocrine system Help restore the balance of hormones in our bodies Conduct basic research to learn how certain glands work. With this they decide on the treatment that will be given to the patient. Through research, new drugs and treatments are found for hormone problems.

17. Exam MRI Inserted a catether into the veins of the adrenal glands and determined the left gland grew Abdominal CT scan EKG- abnormal

18. MRI • Shows which adrenal gland is the one producing excessive hormones

19. Treatment Amiloride and triamaterene

20. Hyperaldosteronism Also called “Conn’s Syndrome” Most cases of primary hyperaldosteronism are caused by a noncancerous (benign) tumor of the adrenal gland. Two types: Primary and Secondary Symptoms: Primary Hyperaldosteronism- Secondary Hyperaldosteronism- fatigue, headache, temporary paralysis, muscle weakness, and numbness. Complications: Primary Hyperaldosteronism- high blood pressure and low potassium levels. These cause other problems such as heart attack, heart failure, stroke, excess thirst and urination, or kidney failure. Secondary Hyperaldosteronism- Impotence and gynecomastia (enlarged breasts in men)

21. Prognosis The outlook for primary hyperaldosteronism is good with early diagnosis and treatment. The outlook for secondary hyperaldosteronism depends on the cause of the condition.

22. Prognosis Surgical removal of an adrenal tumor or an adrenalectomy results in complete resolution of symptoms and return to normal blood pressure in about 70% of cases. If a tumor is responsible for the disease but cannot be removed, or if both adrenals are involved, the prognosis remains excellent with treatment. If hyperaldosteronism is untreated or if treatment is delayed, irreversible damage to the heart and/or kidneys can occur. Depending on the extent of such damage, the prognosis may be less optimistic.

23. Life after Hyperaldosteronism Professor at ECSU Symptoms disappeared after he recovered from his surgery Lives happily with his wife and son.

24. Sources 1 "Cardiology Case Study 23 Progress Notes." Web Link Redirector. N.p., n.d. Web. 4 June 2012. <http://www2.kumc.edu/instruction/pharmacy/old_cardiocases/case23/progress.html>. "Cardiologist Job Description." Health Care Salary Online . N.p., n.d. Web. 4 June 2012. <http://www.healthcaresalaryonline.com/cardiologist-job-description.html>. "Cardiologist Job Description and Duties." Sample Resume Examples and Writing Tips. N.p., n.d. Web. 4 June 2012. <http://www.bestsampleresume.com/job-descriptions/cardiologist.html>. http://health.nytimes.com/health/guides/disease/hyperaldosteronism-primary-and-secondary/overview.html

25. Sources 2 A.D.A.M Medical Encyclopedia. PubMed Health. 26 July 2011. 2 June 2012 <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004167/>. "Aldosteronism Prognosis - Medical Disability Guidelines." Disability Guidelines – Return to Work Durations and Treatment - MDGuidelines. N.p., n.d. Web. 4 June 2012. <http://www.mdguidelines.com/aldosteronism/prognosis>. AAES. The American Association of Endocrine Surgeon. nd. 30 May 2012 <http://endocrinediseases.org/adrenal/hyperaldosteronism_symptoms.shtml>. Chorousos, G.P. MedScape. 10 May 2012. 4 June 2012 <http://emedicine.medscape.com/article/920713-overview>. Rennert, N. MD. Penn State Hershey: Hyperaldosteronism- primary and secondary. 26 July 2011. 31 May 2012 <http://printer-friendly.adam.com/content.aspx?productId=117&pid=1&gid=000330&c_custid=758>.

26. Sources 3 Rull, G. PhD. Patient.co.uk. 28 January 2011. 28 May 2012 <http://www.patient.co.uk/doctor/Hyperaldosteronism.htm>. Unknown. Blog Spot: Diagnosis: Hyperaldosteronism (Conn's Disease). 10 November 2008. 1 June 2012 <http://hyperaldosteronism.blogspot.com/2008/11/my-symptoms.html>. unknown. "Masonic Health Care." nd. Hosptials World Wide. 3 June 2012 <http://www.hospitalsworldwide.com/listings/604.php>. Unknown. Right Diagnosis. 1 February 2012. 30 May 2012 <http:rightdiagnosis.com/h/hyperaldsteronism_induced_hypertension/prognosis.htm>.