Endocrine Abstracts

A patient, 24 y/o male, presented with the regular occurrence of severe hypertension for past two years: 150-170/100 mmHg. He complained of occasional vertigo, fatigue, and rare muscle cramps. The laboratory findings showed marked hypokalemia–2.7 mmol/l. Thyroid function tests, creatinine, magnesium levels were normal. Heart US showed septal thickening. He had been taking spironolactone 50 mg/day according to the prescription of his cardiologist for the last 2 weeks. Based on patient’s history, clinical presentation, and lab findings, primary aldosteronism was suspected. We recommended withdrawing spironolactone and temporarily replacing it with verapamil and measuring the levels of aldosterone and renin in 4 weeks after withdrawal. The levels of aldosterone and renin were measured after a month of withdrawal of spironolactone. Renin levels were completely suppressed: <1 ng/l (normal range 1.7-23.9 ng/l), and the aldosterone/renin ratio was markedly increased: >218. Aldosterone levels were borderline elevated: 218 ng/l (normal range 11.7-236 ng/l), probably due to hypokalemia which could not be fixed even with a high-dose potassium therapy. We did not conduct confirmatory tests as diagnosis of primary aldosteronism was evident. The CT scan with contrast was performed that revealed 1 cm adenoma in the left adrenal gland. Due to patient’s young age, presence of hypertension, hypokalemia and high aldosterone/renin ratio, the diagnosis of Conn’s syndrome (primary aldosteronism caused by aldosterone-producing adenoma) was indubitable. AVS was not recommended. The patient had been prepared for surgery with 50 mg spironolactone therapy. His potassium was normal and blood pressure normalized after 2 weeks of spironolactone therapy. A laparascopic adrenalectomy was performed in September 2022. Spironolactone was withdrawn after the surgery. Potassium level in blood in two weeks postoperatively was 4.7 mmol/l, blood pressure decreased (120/75 mmHg to 130/90 mmHg). Prompt improvement in blood pressure indicates that most probably he had short duration of aldosteronism and process was completely reversible. He was recommended to monitor his blood pressure regularly without any additional treatment.