Conn’s Syndrome

Conn’s Syndrome, also known as primary hyperaldosteronism, is a medical condition characterised by the overproduction of the hormone aldosterone by the adrenal glands. This excess aldosterone disrupts the balance of sodium and potassium in the bloodstream, leading to increased sodium retention and potassium excretion. Consequently, patients typically develop high blood pressure (hypertension) that is difficult to control, alongside electrolyte imbalances that may affect multiple body systems.

Dr Ben Ng

Senior Consultant Endocrinologist

Dr Donovan Tay

Senior Consultant Endocrinologist

Symptoms of Conn’s Syndrome

Patients with Conn’s Syndrome may present with several characteristic symptoms, though some individuals may experience minimal or no symptoms despite having the condition.

Resistant Hypertension

Blood pressure remains elevated despite taking three or more antihypertensive medications, including a diuretic. The hypertension typically shows limited response to standard treatments.
Hypokalaemia (Low Potassium Levels)

Reduced potassium levels in the blood can cause muscle weakness, fatigue, and in severe cases, paralysis or heart rhythm abnormalities.
Muscle Cramps and Weakness

Electrolyte imbalances affect muscle function, resulting in cramps, spasms, or generalised weakness, particularly in the legs.
Headaches

Persistent headaches may occur due to elevated blood pressure affecting blood vessels in the brain.
Fatigue

General tiredness and reduced energy levels can result from electrolyte imbalances and their effects on muscle and nerve function.

Causes and Risk Factors

Multiple factors can contribute to the development of Conn’s Syndrome, each affecting the normal function of the adrenal glands in different ways.

Adrenal Adenoma

A benign tumour in one of the adrenal glands (aldosterone-producing adenoma) causes excessive aldosterone production. These adenomas generally occur spontaneously and are not hereditary.

Bilateral Adrenal Hyperplasia

Both adrenal glands become enlarged and produce excess aldosterone. This form tends to develop gradually and may have genetic components.

Genetic Factors

Certain genetic mutations affect aldosterone production and regulation. These include mutations in ion channel genes and enzymes involved in aldosterone synthesis.

Age

The condition most commonly develops between ages 30 and 50, though it can occur at any age. The incidence increases with advancing age.

Diagnostic Methods

Blood Tests

Initial screening measures aldosterone and renin levels to calculate the aldosterone-to-renin ratio (ARR). An elevated ARR suggests primary hyperaldosteronism. Additional tests assess electrolyte levels, particularly potassium, and kidney function. Standardised conditions, including medication adjustments, are required for accurate results.

Confirmatory Tests

If screening indicates Conn’s Syndrome, further tests determine whether aldosterone production is autonomous. These include the saline infusion test, which assesses whether aldosterone levels remain elevated despite suppression attempts.

Imaging Studies

CT or MRI scans of the adrenal glands help detect adenomas, hyperplasia, or rare carcinomas. However, imaging alone cannot confirm whether a lesion is responsible for excessive aldosterone production, particularly in patients over 35 who may have non-functioning adrenal nodules.

Adrenal Vein Sampling (AVS)

This procedure measures aldosterone levels from each adrenal gland separately. A catheter collects blood samples directly from the adrenal veins, helping determine whether excess aldosterone originates from one or both glands.

Treatment Options

Management of Conn’s Syndrome focuses on controlling aldosterone levels, normalising potassium, and managing blood pressure.

Surgical Intervention

Following the identification of the offending adenoma,the lesion is removed resulting in a biochemical cure.
Mineralocorticoid Receptor Antagonists

Medications such as spironolactone and eplerenone block aldosterone receptors, reducing their effects on the kidneys. Spironolactone is more potent but may cause hormonal side effects, while eplerenone offers a more selective option with fewer side effects.
Other Antihypertensive Medications

Calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers may be used alongside mineralocorticoid receptor antagonists for additional blood pressure control, particularly in cases of bilateral adrenal hyperplasia.
Potassium Supplements

If aldosterone excess causes significant potassium loss, oral potassium chloride supplements help restore normal levels. Regular monitoring ensures appropriate dosage adjustments.

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Prevention and Management

While Conn’s Syndrome cannot be prevented, effective management helps reduce complications and improve quality of life. Regular monitoring of blood pressure and electrolytes ensures timely medication adjustments. Lifestyle changes, such as reducing sodium intake, staying active, and maintaining a healthy weight, can enhance treatment effectiveness. Routine follow-ups are necessary, particularly in the first year after diagnosis or treatment. Patients who undergo adrenalectomy require long-term monitoring for recurrence or adrenal insufficiency.

Frequently Asked Questions

Can diet alone manage Conn’s Syndrome?

While reducing sodium intake can support treatment and help control blood pressure, dietary changes alone are not enough to manage Conn’s Syndrome. Medication is typically required to regulate aldosterone levels effectively.

Can Conn’s Syndrome be mistaken for other conditions?

Yes, it is often misdiagnosed as essential hypertension, especially in patients with high blood pressure that does not respond well to standard treatments. This can lead to delayed diagnosis and appropriate management.

Can Conn’s Syndrome recur after treatment?

If managed with medication, symptoms will return if treatment is discontinued. In some cases, long-term monitoring is necessary to detect any changes in aldosterone levels, particularly in individuals with underlying factors such as bilateral adrenal hyperplasia.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Adj Asst Professor Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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