Understanding Conn Syndrome: A Hidden Cause of Hypertension

Conn syndrome, also known as primary hyperaldosteronism, is an increasingly recognized condition, particularly in younger patients with resistant hypertension. This disorder is characterized by excess production of the hormone aldosterone, often leading to hypokalaemia—low potassium levels in the blood. The incidence of Conn syndrome appears to be higher in women in their thirties, making it important for healthcare professionals to consider this diagnosis when faced with patients presenting with marked hypertension that does not respond to multiple antihypertensive medications.

Diagnosing Conn syndrome requires a careful assessment of the renin-angiotensin-aldosterone axis. Initial screening involves measuring plasma levels of aldosterone and renin. However, this process can be complicated by the concurrent use of antihypertensive medications. In particular, mineralocorticoid receptor (MR) antagonists like spironolactone must be withdrawn for at least four weeks prior to testing. The challenge lies in balancing the need for accurate diagnostic results with the potential dangers of uncontrolled hypertension in the patient.

A comprehensive case study demonstrates the diagnostic pathway associated with Conn syndrome. In this instance, a 44-year-old woman presented with symptoms including weight gain, nocturia, and notably high blood pressure. Upon examination, she also exhibited physical signs such as a flushed complexion and purple stretch marks. The diagnostic process involved multiple tests, leading to the identification of underlying hyperaldosteronism. Furthermore, imaging studies such as MRI or CT scans can help localize the source of aldosterone excess, whether from an adenoma or bilateral adrenal hyperplasia.

Treatment for Conn syndrome primarily centers on the type of pathology identified. If a Conn tumor is present, unilateral adrenalectomy is typically the preferred intervention, which can often lead to significant improvements in hypertension. Conversely, patients with bilateral hyperplasia or those who are not fit for surgery may require management through medication. Spironolactone has long been recognized as an effective MR antagonist for these cases, often resulting in a noticeable reduction in blood pressure that had previously been resistant to treatment.

The importance of considering Conn syndrome and other unusual causes of hypertension cannot be overstated, particularly in younger individuals. Healthcare providers should maintain a high index of suspicion and perform appropriate screenings to ensure timely diagnosis and effective management. As the understanding of this condition evolves, so too does the potential for improved outcomes for patients who have long struggled with resistant hypertension.