A Patient with Severe Hypertension Caused by Rarely Found Condition (Conn’s Syndrome)

Background: Conn’s Syndrome is a primary aldosteronism (PA) caused by adrenal adenoma(s) and characterized by increased aldosterone secretion from the adrenal glands, suppressed plasma renin, hypertension, and hypokalemia. In Indonesia, it is considered rare because of the low reported case. World widely, it is estimated that more than 98% of all Conn’s syndrome patients are never detected or treated, resulting in unnecessary strokes, heart attacks, and heart failure. Case presentation: We reported a 52-year-old male with chief complaint of headache and severe hypertension (225/143 mmHg). He had hypertension for more than five years with 3-4 antihypertension medications and histories of hypokalemia. The patient had been prescribed oral potassium supplements for years from different doctors and never been really told to work up on his disease. He had low potassium level (2.1 mmol/L) and metabolic alkalosis. His examination showed that he had high plasma aldosterone concentration (PAC), 46.7 ng/dL, and low plasma renin activity (PRA), 0.1 ng/mL/h. A unilateral nodule was found on his right adrenal gland from MRI. The patient then went for primary aldosteronism treatment and being planned for surgery. Dicussion: The triad for Conn’s syndrome is hypertension, hypokalemia, and metabolic alkalosis. Because of the high aldosterone/renin ratio (467 ng/dL per ng/mL/h), PA diagnosis was made. While this patient was a good candidate for surgery as only having a single adrenal adenoma, by giving spironolactone 100 mg/day his blood pressure and hypokalemia could be controlled. Conclusion: Primary aldosteronism are quite common in the general population, yet they go mostly unnoticed.