Endocrine Abstracts

Background: Hypertension affects 28.6% of adults in the United States. In most, hypertension is primary (essential or idiopathic), but a subgroup of approximately 15% has secondary hypertension. In young adults (<40 years old), the prevalence of secondary hypertension is approximately 30%. Endocrine disorders remain one of the leading causes of secondary hypertension. Primary aldosteronism (Conn’s syndrome), Once thought to be a rare condition and not worth investigating in patients with hypertension unless hypokalemic, however, it’s now considered the most common, specifically treatable, and potentially curable form of hypertension, accounting for at least 5% to 10% of hypertensive patients, with most patients normokalemic.

Clinical Presentation: A 33-year-old male has presented with recurrent attacks of dizziness, muscle pain and fatigue every few months, which was treated conservatively in ER by IV Fluid. His PMH include uncontrolled hypertension diagnosed since 2015, he had visited many specialized centres for his condition. His current medications list includes; amlodipine 5 mg, valsartan 160 mg and hydrochlorothiazide 12.5 mg. On examination is BMI is 22 kg/m², he is anxious, his blood pressure is 150/100 mmHg, the abdomen is soft, no masses, there is no radio-femoral delay and no renal bruit can be detected.

Investigations: • S.Potassium: 2.5 mg/dl.

• Renin: 2.6 pg/ml, aldosterone: 373 pg/ml, and Aldosterone Renin Ratio (ARR) of 66.9 (normally <25).

• Echo: LVH

• CT of adrenal glands shows right adrenal mass 20 mm, 15 HU, which increases to 30 HU after contrast.

Treatment: the patient had been referred to surgery and the team decided to do laparoscopic unilateral adrenalectomy. The histopathology confirms the diagnosis.

Outcome: The operation normalized his aldosterone level (from 373 to 62 pg/ml), and with continuous follow-up, still the patient is normotensive without any hypertensive medications.

Conclusion and Take Home Messages: First: always think of secondary causes of hypertension in young patients especially if it’s resistant to therapy, as hypertension may be the initial clinical presentation for at least 15 endocrine disorders. Second: don’t depend on serum potassium as a screening test for primary hyperaldosteronism, and Third: Aldosterone Renin Ratio (ARR) remains the gold-standard test for screening of primary hyperaldosteronism.