Abstract P253: Forty-Two Year Followup in a Patient With Conn's Syndrome

Abstract

This case report relies on detailed hospital and clinic records from the UK provided by the patient for review and synthesis. In 1977 a 24 y/o M college student in the UK was found to have asymptomatic HTN (245/125) during a routine exam and was admitted one day later for evaluation. He had no FH of HTN or low K. FH + for CAD before age 60. A renal arteriogram was normal. Hypokalemic alkalosis was noted as was an elevated plasma aldosterone (PALDO), but normal urine Aldo. Adrenal CT showed a normal L adrenal but the R was not seen. Adrenal venography was negative but the R adrenal could not be cannulated. The interpretation was bilateral disease. Spironolactone (S) was started at 300 mg/d. Admitted for surgery 2 months later the BP 160/100 and K was normal. At surgery, the L adrenal was estimated to be 2x normal size and was excised as was 1/2 of the R adrenal. Adrenal steroid coverage was used for 2 months, then ACTH gel was given for 2 months and stopped. BP was lowered for about 2 months but then returned to 200/110. S was started at 400 mg/d with good control but gynecomastia developed. BP control was attempted with S and hydrazine (H) for several years but despite being normal at home was always high in the office. Age 33 was noted to have a K or 3.2 and muscle “fascillcuations”. Age 51, atrial fibrillation developed/converted with Amiodarone. BP continued to be difficult to control until he began DASH eating plan at age 56 when he joined the Yahoo Group hyp e raldostreronism@yahoogroups.com which I have managed for 16 years. He retired from teaching math at age 58 early to care for his wife. Age 62 PALDO was 1300 and Renin was 10 on S and DASH diet (ENa 55, EK 139 mM/d) and then 600/1 off S and on high salt intake (ENa, 125 EK 100 mM/d). Age 60 MRI showed adenoma L adrenal. Rx with S and enalapril continued with home BPs 122/84. At age 65 non-ST MI was diagnosed and PTA and stenting was performed. BP has been stable for last year with home BP 120/80 on DASH Diet, Spiro 100 mg/d and enalapril 30 mg/d. Statin myalgia has prevented their use but lipids have improved on DASH. This case illustrates that long-term survival after 3/4 adrenalectomy for Conn’s syndrome is possible but that BP management can be difficult.