Endocrine Abstracts

A 65-year-old Moroccan man was regularly followed in the outpatient clinic for type 2 diabetes since 2010 and was well controlled with an oral treatment. His past medical history included severe hypertension since 1985. Despite four antihypertensive agents, his blood pressure was not controlled (BP: 220/120 mmHg). A suspicion of renal artery stenosis was excluded by an invasive procedure.

He presented an impaired renal function (GFR: 50 ml/min) and his serum potassium level was 2.7 mmol/l. The renin aldosterone ratio at 26 and a high 24 h urinary aldosterone value, were compatible with a diagnosis of primary hyperaldosteronism. A 5 h rhythm of serum aldosterone/renin/ACTH/cortisol showed a correlation between aldosterone and ACTH/cortisol, but not with renin suggesting the presence of an adenoma.

CT scan of the abdomen showed a right adrenal mass ~1.2 cm in diameter. The results of the adrenal veins sampling correlated with a right lateralization.

He was referred for adrenalectomy, which was carried out laparoscopically. His blood pressure dropped and his serum potassium normalized, but he still needed treatment, although with less antihypertensive agents.

In the absence of proper treatment, patients with hyperaldosteronism suffer from poorly controlled hypertension, which may be associated with increased rates of stroke, heart disease, and kidney failure. Delay in the diagnose of hyperaldosteronism may be fatal.

Luckily it was not the case despite 30 years of undiagnosed Conn’s syndrome.

Keywords: Hypertension, hyperaldosteronism, adrenalectomy