What are the Symptoms of Conn's Syndrome / Hyperaldosteronism?
If the adrenal tumor is overproducing aldosterone, then you have a disease called primary hyperaldosteronism, also called Conn's Syndrome (Conn's tumor) after Dr. Conn, who first described this disease. The signs and symptoms associated with Conn's Syndrome (primary hyperaldosteronism) include low potassium in the blood (causing frequent urination), muscle cramps and heart palpitations (feeling your heart racing). These symptoms include fatigue, anxiety, depression, headache, and memory difficulties. High blood pressure is also associated with excess production of aldosterone (Conn's Syndrome). If you ever have high blood pressure and low potassium, you should definitely be investigated to make sure you don’t have an aldosterone-producing adrenocortical tumor. Conn's syndrome can also cause, what we call with a medical term, "neurocognitive" symptoms. These symptoms describe how we feel, and how our brain works.
Most patients with primary hyperaldosteronism (aldosteronoma or Conn's tumor) have high blood pressure. If you have high blood pressure especially if you’re relatively young and have no other risk factors such as diabetes or a family history of high blood pressure, you need to make sure you don’t have an adrenal tumor overproducing aldosterone. It is important to know that almost 50% of all patients with primary hyperaldosteronism (aldosteronoma or Conn's tumor) are asymptomatic. They may feel normal and maybe the only sign is high blood pressure. However, if they don’t have their adrenal tumor removed, the patients are at a tenfold increased risk of heart arrhythmias, stroke, and heart attacks.
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Do All Patients with Conn's Syndrome / Hyperaldosteronism Have Symptoms?
NO. Often, the only sign that anything is wrong may by hypertension (mild to severe high blood pressure). Classicly, the blood pressure is mostly diastolic (the lower number is high while the systolic (the upper number) is normal. If hypokalemia is present (hypokalemia means low blood potassium; only about 9-37 % have low blood potassium levels) is present then the patient may have nocturia (urination at night time), polyuria (frequent urination), muscle cramps, and palpitations (raising heart beat). Remember, many patients are completetly asymptomatic. This means they have no symptoms at all. This is why it is so important to screen for patients, because otherwise they go undiagnosed and untreated, leading to unnecessary complications such as heart arrhythmias, stroke, heart attacks and premature death.
Need for Screening for Conn's Syndrome and Aldosterone Producing Adrenal Tumors. As mentioned, 4-10% of all patients with high blood pressure have underlying primary hyperaldosteronism that nobody has figure out. It is estimated that 75 million Americans suffer from hypertension. This means that there are about 3-7.5 million Americans with primary hyperaldosteronism. Only a fraction of all these -- less than one tenth of one percent -- are being diagnosed, and an even smaller fraction are being offered surgery. With minimally invasive adrenalectomy, the vast majority of these patients can be cured in less than 30-40 minutes. Surgical removal of the adrenal tumor may save you from developing future strokes, heart attacks, and arrhythmias (for instance, atrial fibrillation), and premature death. This is why people with high blood pressure need to be screened for this disease.
Who Should be Tested for an Aldosterone-Secreting Adrenal Tumor and Conn's Syndrome / Hyperaldosteronism?If you belong to any of the below groups, you need to be screened for primary hyperaldosteronism. Screening is easy. Ask our doctor, via a simple blood test, to check your plasma aldosterone concentration (PAC) and plasma renin activity (PRA). If dividing the PAC by the PRA: PAC/PRA (this is called ARR; aldosterone-renin ratio) the result is greater than 20, you may have primary hyperaldosteronism. This screening test is the ARR test. If you belong to any of the below groups, you need to be screened for primary hyperaldosteronism. If you belong to one of these groups, print this page out, bring it to your doctor and ask to be screened for an Aldosterone-Secreting Adrenal Tumor and Conn's Syndrome.
- Drug-resistant hypertension (i.e. blood pressure that is not controlled well with medications)
- Hypertension requiring many medications
- Hypertension requiring being on Spironolactone (Aldactone), Eplerenone (Inspra) or Amiloride
- Hypertension of any grade, especially without known risk factors such as advanced age, kidney problems, diabetes, obesity, etc.
- Hypertension at a young age (< 50 years of age)
- Hypertension with low blood potassium (hypokalemia)
- Hypertension with an adrenal incidentaloma (any adrenal tumor on CT scan)
- Hypertension and sleep apnea
- Hypertension and a family history of early-onset (< 50 years of age) hypertension or cerebrovascular accident (stroke) at a young age
- Hypertension in a family with any family member with an adrenal tumor (whether a Conn tumor, Cushing’s syndrome or pheochromocytoma/paraganglioma)
- Hypertension that is episodic (paroxysmal)