Primary hyperaldosteronism in a 58-year-old Nigerian man with difficult to treat hypertension

Abstract

Conns syndrome is a known cause of secondary hypertension. It is not commonly reported in low-income nations like Nigeria and many cases could be wrongly managed as primary hypertension due to low index of suspicion on the part of the clinicians, inadequate diagnostic tests or non-availability of funds for these tests. This could lead to poor treatment outcome. We present the case management of the patient and reviewed the literature. A 58-year-old male with history of poor blood pressure control, recurrent body weakness and palpitation was referred to the nephrology unit for further management. Examination revealed thickened arterial wall, elevated blood pressure, an enlarged heart and a fourth heart sound. The serum potassium was low, this was corrected. Laboratory investigations revealed elevated urine potassium and serum aldosterone-to-renin ratio. Ultrasound scan showed normal-sized echogenic kidneys, electrocardiogram showed left ventricular hypertrophy (LVH) and echocardiogram showed LVH, mild left ventricular dilatation and mild aortic valve regurgitation. Computed tomography revealed bilaterally enlarged adrenal glands. He was managed for Conns syndrome and responded well to salt restriction, eplerenone and other BP-lowering drugs. This case confirms that with a very high index of suspicion and the availability of specific laboratory tests and advance radiological investigations, more cases of Conns would be diagnosed and patients are more likely to receive better treatment with more favourable outcome.