MBBS OSCE · General Medicine
OSCE — Primary Aldosteronism (Conn Syndrome)
Eight-minute OSCE station on Primary Aldosteronism (Conn Syndrome): focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Primary Aldosteronism (Conn Syndrome).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Primary aldosteronism is autonomous aldosterone secretion that is independent of renin (high aldosterone, suppressed renin), causing sodium retention with hypertension, and potassium and hydrogen loss with hypokalaemic metabolic alkalosis. It is the commonest cause of secondary hypertension, affecting 5 to 10 percent of all hypertensives and over 20 percent of those with resistant hypertension, yet is frequently missed because most patients are normokalaemic. Causes are bilateral idiopathic adrenal hyperplasia (commonest), a unilateral aldosterone-producing adenoma (Conn syndrome), unilateral adrenal hyperplasia, and familial hyperaldosteronism types I to IV. Screen at-risk patients with the
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Resistant hypertension with spontaneous or diuretic-induced hypokalaemia — scree |
| Safety | Young patient (under 40) with hypertension and hypokalaemia, or a family history |
| Safety | Hypertension with hypokalaemia and metabolic alkalosis — the Conn triad; check r |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.