Diagnosis of adenomatous primary aldosteronism in a patient with severe hypertension.

BACKGROUND: A 27-year-old woman presented to her primary-care physician with severe hypertension after complaining of fatigue over the preceding months. She was otherwise asymptomatic. She was referred to a hypertension clinic and was found to be hypokalemic. She was immediately commenced on amlodipine, with atenolol added 2 weeks later. After 4 weeks of this drug therapy, her hypertension persisted and investigations to exclude secondary causes of hypertension were performed.

INVESTIGATIONS: Aldosterone and renin levels were measured under controlled conditions and the results expressed as an aldosterone-to-renin ratio. CT of the adrenal glands was also performed.

DIAGNOSIS: Adenomatous primary aldosteronism (Conn's syndrome).

MANAGEMENT: The patient was initially treated with spironolactone before undergoing a laparoscopic left adrenalectomy.