Endocrine Abstracts

62 year-old lady with a long history of hypokalaemia, hypertension and a random aldosterone of 786 pmol/l with suppressed renin of <8.0 mU/l at a time when she was taking Nebivolol, perindopril and Felodipine. Her Hypokalaemia improved after addition of Spironolactone and remained above 3.5 mmol/l. Biochemical work up confirmed a diagnosis of Conn’s syndrome and her BP control improved after addition of Aldosterone antagonist as above. Adrenal MRI revealed a 13 mm adrenal adenoma on left side. Patient refused surgery and a conservative approach was pursued with reasonable control of BP on 4 agents including Spironolactone. A few months later, she sustained an acute kidney injury secondary to dehydration. Following her recovery from this, over successive weeks antihypertensives were stopped due to hypotension. Eventually Spironolactone was also stopped due to persistent hyperkalemia. Repeat Biochemical testing showed serum aldosterone was <30 pmol/l and normal Renin. MRI Adrenal was repeated that showed a significant reduction in the size of the left adrenal adenoma that measured 7.5 mm×8 mm having previously been 12 mm×15 mm with a radiological evidence of fat necrosis probably due to auto infarction of her adrenal adenoma. This possibly occurred during the period of acute kidney injury, hypotension and dehydration. We present a fascinating case of Conn syndrome in which symptoms resolved following infarction of adrenal nodule due to AKI/dehydration/hypotension.