Resistant Hypertension Due to Primary Aldosteronism - A Case Report

By definition, resistant hypertension means blood pressure that remains above the goal inspite of concurrent use of three antihypertensive drugs of different classes, of which one should be a diuretic. One of the causes of resistant hypertension is primary aldosteronism, or Conn’s disease. These adrenal adenomas are often missed on ultrasound abdomen examination and may remain undiagnosed. Such patients have episodes of hypokalemia, and often they only receive potassium supplementation without a definitive diagnosis. It is estimated that less than 1.5% of hypertensive patients and less than 0.3% of the general adult population have primary aldosteronism. A high level of suspicion is required to diagnose primary aldosteronism when the patient presents with resistant hypertension, hypokalemia, and a normal USG abdomen. We present a case of a female who presented to us with hypertension refractory to 3 antihypertensives who had repeated episodes of hypokalemia which was conservatively managed at different hospitals, who came to our hospital with the same complaints and was diagnosed to have a left-sided aldosterone-producing adenoma on CECT abdomen. Laparoscopic left adrenalectomy succeeded in normalizing her potassium levels and keeping her BP under control on 1 antihypertensive medication. Blood pressure that remains above the target level in spite of simultaneous use of 3 anti-hypertensive medications of different classes, of which one is a diuretic, is called resistant hypertension. One of the causes of this condition is an aldosterone-secreting adrenal adenoma/Conn’s disease. The causes of unilateral aldosterone hypersecretion include Conn’s adenoma, primary unilateral adrenal hyperplasia and rarely, aldosterone-producing adrenocortical carcinoma. It is estimated that primary aldosteronism is seen in 1.5% of the hypertensive population and around 0.3% of the general adult population, but it may be 23% or more in patients diagnosed as having resistant hypertension. These patients have hypokalemia, which can result in serious cardiac complications. It is a surgically correctable cause of hypertension and a high level of suspicion is required when a patient presents with hypertension with hypokalemia, or a patient with resistant hypertension. We present a case of a female who presented to us with hypertension refractory to 3 anti hypertensives with repeated episodes of hypokalemia, which was then investigated to be diagnosed as left-sided aldosterone-producing adenoma.