Abstract
Disclosure: A. khan: None. A. Pandharpurkar: None. M. Baksh: None. M. Kherallah: None.
Introduction: Primary hyperaldosteronism is a frequently underdiagnosed cause of secondary hypertension, affecting about 10% of cases. Conn et al. identified the triad of resistant hypertension, hypokalemia, and metabolic alkalosis due to excessive aldosterone secretion, impacting the RAAS. This case report discusses a case of resistant hypertension with delayed diagnosis of primary aldosteronism, leading to complications. It highlights the need for early detection and timely management of endocrine causes like Conn's syndrome to prevent complications and reduce healthcare costs. Case Presentation: A 47-year-old male with hypertension, and Diabetes Mellitus reported home BP of 160-180 mmHg, while office readings exceeded 200 SBP despite compliance with HCTZ, Carvedilol, Valsartan, and Spironolactone. He developed bilateral retinal hemorrhages and a left vitreous hemorrhage. A planned vitrectomy was canceled due to critically high blood pressure, leading to an emergency room referral. Multiple hospitalizations for hypertensive crises, including an intracranial hemorrhage, required the urgent need for effective management. CT scan, laboratory tests, and adrenal vein sampling indicated significant aldosterone hypersecretion from the left adrenal gland. The left adrenal vein showed elevated aldosterone levels (4,160 ng/dL) and a high aldosterone/cortisol ratio (3.98). The LAC:RAC ratio of 5.24:1 confirmed lateralization. These findings suggest the left adrenal adenoma contributed to the hormonal imbalance, necessitating targeted surgical intervention to manage hyperaldosteronism effectively. Discussion: Secondary hypertension accounts for 29.6% of young hypertensive patients, with Conn's syndrome being a leading cause. The prevalence of Conn's syndrome is 10% in general practice, rising to 30% when screened with the aldosterone-to-renin ratio. Guidelines recommend screening high-risk patients to confirm primary aldosteronism and identify subtypes via adrenal CT scans. Early detection can prevent complications; however, studies show only 9.6% of eligible patients are screened, indicating barriers such as limited awareness and resources. Further research is needed to improve screening, especially in young patients, to prevent organ damage. Conclusion: The delayed diagnosis in this case resulted in significant morbidity and increased healthcare costs, highlighting the need for comprehensive evaluations and timely endocrinologist referrals. Early detection and effective management of resistant hypertension through appropriate screening and specialist involvement are crucial. Improving clinician education on secondary hypertension and enhancing access to diagnostic tools can significantly enhance patient outcomes and optimize healthcare resources.
Presentation: Monday, July 14, 2025