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Conn’s syndrome treatment: What’s best for me?

Conn's syndrome, also known as primary hyperaldosteronism or primary aldosteronism (PA), is a hormonal disorder that affects the adrenal glands. It is caused by the overproduction of aldosterone, a hormone that regulates salt and water balance in the body. This overproduction can lead to high blood pressure, low potassium levels (although most patients have normal potassium), and other health problems.

Find out why Conn’s syndrome is a silent killer.

Further, Conn’s syndrome can severely affect a patient’s quality of life. While there are several treatment options available for Conn's syndrome, surgery is often the most effective and preferred choice when the extra aldosterone comes from one adrenal gland. Medications treat the effects of aldosterone; they don’t fix the underlying problem: the adrenal tumor.

Conn’s syndrome treatment: Will medication work?

Treatment options for Conn’s syndrome include medications that can help to reduce the production of aldosterone or block its effects on the body. These medications are appropriate for mild Conn’s syndrome, for disease coming from both adrenal glands, and for patients who are not candidates for surgery. However, they do not address the root cause, and for disease coming from one adrenal gland they are less effective than surgery. The most common medications to treat Conn’s syndrome are anti-hypertensive medications such as the aldosterone antagonists spironolactone or eplerenone or other potassium-sparing diuretics like amiloride. Often patients are being put on one blood pressure medication after another and are never diagnosed with Conn’s syndrome. It is of course good to treat high blood pressure acutely as a bridge to adrenal surgery which is curative, but do not get stuck on just taking blood pressure medications with no plan of fixing the underlying cause.

Conn’s syndrome treatment: Is surgery a better option?

When it comes to Conn's syndrome treatment, surgery is the preferred option for several reasons. First, surgery is the only treatment that can cure the condition: when the disease comes from one adrenal gland, the aldosterone excess is cured in the large majority of patients (about 94% in a large international study). Surgical treatment for Conn's syndrome involves removing the affected tumor of the adrenal gland or glands. This procedure (adrenalectomy) can be performed using several different techniques. Read more about the different types of adrenal surgery here: https://www.adrenal.com/adrenal-surgery/adrenal-surgery-techniques

Another advantage of surgical treatment is that it can be performed relatively quickly and with minimal downtime. Most patients of the Carling Adrenal Center are able to return to light normal activities within a few days of the procedure, with little to no long-term side effects. Of course, this is highly dependent on the experience of your adrenal surgeon.

Figure 1. Typical aldosterone producing adrenal tumor causing Conn’s syndrome after it was removed.

Conn’s syndrome treatment: Which adrenal surgeon and operation are best?

Dr. Carling is one of the world’s most experienced adrenal surgeons, and he personally performs every operation. When performed by Dr. Carling, a mini back scope adrenalectomy (MBSA) for hyperaldosteronism (Conn's Syndrome) typically takes about 20 minutes.

In our view, the best operation for removing the adrenal tumor that is causing hyperaldosteronism and Conn's syndrome is the MBSA. The operation can also be called the Mini Posterior Retroperitoneoscopic Adrenalectomy, because the operation is performed with very small scopes that go through the lower, outer back. The Mini Back Scope Adrenalectomy (MBSA) is the technique we use in more than 95% of our operations, and in nearly all patients with primary hyperaldosteronism.

Read more about the MBSA procedure here: https://www.adrenal.com/adrenal-surgery/mini-scope-adrenal-surgery

Figure 2. Dr. Carling performing a mini back scope adrenalectomy (MBSA) for Conn’s syndrome.

Conn’s syndrome treatment: Will I be cured after surgery?

Patients who undergo surgery can expect to see a significant improvement in their blood pressure and potassium levels, as well as a reduction in their risk of developing other health complications associated with the condition. After surgery for Conn’s syndrome, the low potassium usually normalizes first, then the blood pressure will start improving over weeks to a few months. Blood pressure becomes completely normal without medication in roughly a third to a half of patients and improves in most of the rest; younger patients, women, and those with a shorter history of high blood pressure, fewer medications and no kidney damage have the best chance of coming off all pills.

Notably, most patients begin to feel better, younger, and their quality of life significantly improves following surgery. It is unappreciated how poorly patients feel with Conn’s syndrome. For most patients, the symptoms of fatigue, anxiety, depression, headache, memory difficulties, poor sex drive, and muscle cramping improve markedly.

Conn’s syndrome treatment: Don’t wait

Conn’s syndrome can have serious consequences if left untreated. After their adrenalectomy, many patients tell us they wish they had done it sooner. If you have Conn’s syndrome, the best thing you can do for your health is to do your research and be your own advocate. Select the most experienced adrenal surgeon you can find and don’t risk it with a surgeon who has performed only a handful of adrenal operations.

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Author

Dr. Tobias Carling MD, PhD, FACS

Dr. Tobias Carling is a world-recognized endocrine surgeon and adrenal surgery expert, widely regarded as one of the highest-volume adrenal surgeons in the United States and globally. He is the Founder and Surgeon-in-Chief of the Carling Adrenal Center in Tampa, Florida, an international referral center dedicated exclusively to adrenal tumors and adrenal hormone disorders. Prior to founding the Carling Adrenal Center, Dr. Carling spent 17.5 years at Yale University School of Medicine, where he served as Chief of Endocrine Surgery, Associate Professor of Surgery, Endocrine Surgery Fellowship Director, and Founder of the Yale Endocrine Neoplasia Laboratory. His work helped advance the understanding and treatment of adrenal, thyroid, and parathyroid tumors. Dr. Carling specializes in advanced minimally invasive adrenal surgery, including complex and function-preserving adrenalectomy techniques. He holds both an MD and PhD from Uppsala University in Sweden and has published extensively in leading scientific journals, including The New England Journal of Medicine, Nature, Science, and PNAS. He is a Fellow of the American College of Surgeons (FACS) and a member of the American Association of Endocrine Surgeons and the International Association of Endocrine Surgeons. Patients from across the U.S. and around the world seek his expertise for complex adrenal disease.