Abstract P227: Resistant Hypertension In Young Patient- A Case Of Conn’S Syndrome

Abstract

Abstract: Resistant hypertension (HTN) is defined as elevated blood pressure (BP) while being on three different antihypertensive medications at maximum recommended doses which include diuretics or BP that requires four different antihypertensives. One of the secondary causes of resistant HTN is Conn's Syndrome (CS). CS is mainly due to excessive secretions of aldosterone (aldo), Aldo is a mineralocorticoid hormone that maintains sodium and potassium homeostasis. Excessive secretion can result in hypernatremia and hypokalemia. This is a case of a young patient who presented with resistant hypertension and low potassium. Case: A 47-year-old African American with a known history of HTN presented with a seizure-like episode due to elevated BP and low potassium (K) of 2.6 with a creatinine of 2.2 (baseline creatinine 1.2). He was non-compliant with BP medication hydrochlorothiazide. During hospitalization, BP remained elevated with low K even with K supplementation. BP regimen was broadened to amlodipine, carvedilol, hydralazine, losartan, and spironolactone. Further evaluation showed elevated plasma aldo and low renin with a ratio >30. CT abdomen with contrast confirmed a right adrenal gland adenoma measuring 1.8 cm x 2.0 cm. Ultimately, the patient underwent robot-assisted right adrenalectomy, and adrenal vein sampling (AVS) confirmed CS. The right AVS showed an aldo level >3000 ng/dl and the left adrenal aldo level was 37.6 ng/dl. After successful surgery, BP medicines were cut down to spironolactone. A few months later, BP improved, and all medications were discontinued. Discussion: Aldosterone poses proinflammatory, prothrombotic, and profibrotic changes that in the long-term cause end-organ damage. For these reasons, diagnosing hyperaldosteronism early in young patients is crucial to avoid further complications. Adrenalectomy is a treatment of choice in most cases, many patients could also benefit from pharmacotherapy, especially with newer medications that are not anti-androgenic and nonsteroidal like finerenone. Hyperaldosteronism can be simply diagnosed by checking serum morning aldo level and renin level. Therefore, screening for hyperaldosteronism should be done frequently in young patients with resistant HTN.