Primary Hyperaldosteronism

Conn’s Syndrome
  • Non-suppressible hypersecretion of aldosterone
  • Many subtypes – most common are aldosterone-producing adenoma and bilateral idiopathic hyperaldosteronism
  • Hypertension and Hypokalemia are the two major clinical findings
  • Other findings include metabolic alkalosis, mild hypernatremia and hypomagnesemia
  • May be associated with resistant HTN – failure to achieve goal blood pressure despite adherence to appropriate three-drug regimen including a diuretic
  • Begin with plasma renin activity and plasma aldosterone concentration
  • Increased plasma aldosterone to renin ratio and increased plasma aldosterone concentration are both required for the dx of primary aldosteronism
  • Further confirmatory tests include oral salt loading  or saline infusion test
  • Once Dx established – then unilateral aldosterone producing adenoma or carcinoma (rare) must be distinguished from bilateral hyperplasia using CT abdomen and adrenal vein sampling
  • Adrenal CT is the initial test but if CT scan is normal, then adrenal venous sampling to confirm disease especially if the patient would like to pursue surgical management