Endocrine Abstracts

Introduction: Hypertension and diabetes are common causes of kidney failure leading to hemodialysis treatment. Conn syndrome in hemodialysis patients is not very common. Because of it we intend to present a man with hypertension since many years, more and more difficult to treat who in age of 48 years presented with type 2 diabetes. Both diabetes and hypertension were bad controlled (HbA1C=9.6%) and complications in form of retinopathy, coronary disease and atrial fibrillation occurred. Hypertension control was possible only with multi drug therapy (ACE-I, ARB, beta-blocker, a-blocker, clonidine, loop diuretics and spironolactone). In this time the diagnosis of Conn syndrome was done. The patient refused an operation, while conservative therapy was not sufficient to prevent kidney failure. Additional unpleasant consequence of chronic kidney disease was the necessity for discontinuation of spironolactone. There was also nephrotic range of proteinuria observed. The next very big problem was the occurrence of cancer of the left kidney. After nephrectomy, the kidney function deteriorated slow but consequent and dialysis were necessary. After few months we observed polymyalgia rheumatica which was successfully treated with steroid. Despite dialysis therapy, probably as a consequence of hyperaldosteronism the next complication was atherosclerosis with mild cognitive impairment. We observed improvement after beginning of dialysis. Unfortunately, the patient died 12 month from beginning of dialysotherapy because of severe sepsis.

Conclusion: We presented a men with multimorbidity which in a significant part (whole?) is associated with the Conn syndrome.