Case report: Conn's Syndrome

A 67-year old man (BMI 22.8 kg/m²) with hypertension was referred to our clinic in order to optimize blood pressure therapy by preexisting threefold therapy. At presentation the man reported an existing constant need to substitute potassium manifold per day since a longer time. Even if a search for secondary arterial hypertension is not routinely done by a person with an age of 67-years we looked closer due to this special situation. We excluded hyperthyroidism, hypercortisolism or elevated metanephrines. In addition there was no evidence for renal artery stenosis, valvular heart disease or obstructive sleep apnea. After modification of the preexisting therapy was performed we measured levels of aldosterone and renin which showed a quotient over 90. In addition the patient underwent a saline infusion test with a suspicious result for primary hyperaldosteronism. NMR of the abdomen showed a single sided adrenal tumor of 11 mm. To ensure the diagnosis of primary hyperaldosteronism we proceeded with adrenal vein sampling and recieved a ratio of > 10:1 of aldosterone secretion. Correct cannulation of adrenal veins was confirmed by comparing cortisol and adrenal androgen levels on the two sides. The patient is actualy referred to our surgeons and single sided adrenal ectomy is planed.