Conn’s Syndrome

A 35-year-old female presents with uncontrolled hypertension despite maximal triple therapy (atenolol 100mg OD, amlodipine 10mg OD, ramipril 10mg OD). Her BP remains elevated at 168/82 mmHg. She uses a beclomethasone inhaler 100μg BD for asthma. Examination reveals a BMI of 28 kg/m² without cushingoid features. Recent labs show:

Which diagnosis best explains this clinical picture?

A 45-year-old female presents to the cardiology clinic with recurrent episodes of substernal chest pain over the past 3 months. She has a 5-year history of resistant hypertension despite being compliant with triple therapy (ramipril 5mg OD, amlodipine 10mg OD, and indapamide 2.5mg OD). Her current BP is 158/92 mmHg with a regular pulse of 82 bpm. She mentions her elder sister was diagnosed with an “adrenal gland problem causing high BP. Physical examination reveals a thin-built woman (BMI 21 kg/m²) with no cushingoid features or abdominal bruits.

Which abnormality would you expect to find in this patient’s workup if she has primary aldosteronism?

A 35-year-old male presented with uncontrolled hypertension and is currently being managed with lisinopril. On subsequent visit, hydrochlorothiazide was added. After a few days, the patient developed difficulty in walking and tended to fall. Investigation shows normal serum creatinine, CPK, and aldolase levels. However, her potassium is 2.7. What will be the next best test?

A 30-year-old man has a blood pressure of 180/110 mmHg despite good compliance with amlodipine, valsartan, and hydrochlorothiazide. Primary hyperaldosteronism is suspected. Plasma aldosterone: renin to be performed for screening. Which antihypertensive does not interfere with the results and can be used before these investigations? 

A young patient has hypertension and is resistant to the maximum dose of triple antihypertensive therapy. He was recently diagnosed with primary aldosteronism.  Adrenalectomy of either the left or the right is planned. Which one is the most appropriate test that should be done before surgery?

A 42-year-old male shopkeeper from Karachi presents with persistent hypertension despite maximal doses of ramipril 10 mg OD and amlodipine 10 mg OD. His BP remains elevated at 154/86 mmHg. He has no history of diabetes or smoking. Physical examination is unremarkable except for mild pedal edema.

Investigations:

Which of the following represents the best next investigation for this patient?

A young male with hypertension came to OPD with his investigations. He has been extensively investigated and found to have bilateral adrenal hyperplasia resulting in hyperaldosteronism. Which one is the treatment of choice in this condition?