Sumanta Kumer Saha
St. Mary’s Hospital, United KingdomPresentation Title:
A Case of Conn’s Syndrome Presenting with Resistant Hypertension and Hypokalaemia
Abstract
Primary hyperaldosteronism, also known as Conn’s Syndrome, is an uncommon but significant cause of secondary hypertension. We present a unique case of a 38-year-old woman with persistently elevated blood pressure (>220/120 mmHg) despite being on four antihypertensive agents at optimal doses. She also reported fatigue, muscle weakness, and intermittent muscle cramps. Her physical examination was remarkable for sustained hypertension, generalized muscle weakness, and diminished deep tendon reflexes. Laboratory findings revealed hypokalaemia (serum potassium 2.7 mmol/L) and a markedly raised aldosterone/renin ratio (>630), strongly suggestive of primary hyperaldosteronism.
A contrast-enhanced CT scan of the adrenal glands identified a 1.5 × 1.5 cm lesion in the lateral limb of the right adrenal gland, consistent with an aldosterone-producing adenoma. Due to the unavailability of adrenal vein sampling (AVS) and considering the patient's preference, she was started on spironolactone.
Remarkably, her blood pressure normalized and serum potassium levels improved with monotherapy, eliminating the need for multiple antihypertensives. Plans for AVS remain in place to determine whether her condition is due to a unilateral adenoma or bilateral adrenal hyperplasia.
This case underscores the importance of considering Conn’s Syndrome in patients with resistant hypertension and unexplained hypokalaemia. While adrenalectomy is a definitive treatment, AVS plays a critical role in distinguishing between unilateral and bilateral disease before surgical intervention. This case also highlights how strategic medical management with mineralocorticoid receptor antagonists can effectively stabilize patients when surgical decisions are deferred.
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