title: Clinical Case of the Month: PERSISTENT HYPERTENSION IN A YOUNG WOMAN: A CLASSIC PRESENTATION OF CONN'S SYNDROME.
abstract: Primary aldosteronism PA is a secondary cause of hypertension that is often missed due to inadequate clinical evaluation and the lack of classically described laboratory abnormalities. Based on guidelines from the Endocrine Society, primary aldosteronism should be suspected in young patients with moderate to severe hypertension, patients with hypertension and coexisting hypokalemia, any patient with hypertension and an incidental adrenal adenoma, and hypertension in the setting of a significant family history of early onset hypertension or cerebral vascular accident in a first degree relative less than 40 years of age.1 In previous years, primary aldosteronism was attributed to less than one percent of all causes of secondary hypertension. However, recent research and increased utilization of aldosterone plasma renin ratio ARR as a method for screening has led to the understanding that majority of patients with PA are not hypokalemic, and the current literature now places the incidence of PA between 5-13 percent. Additionally, a growing body of evidence has demonstrated inflammatory, fibrotic, and remodeling effects on the cardiovascular and renal tissue that appear to be independent of PA- induced hypertension. Therefore a high suspicion for PA must be incorporated into evaluation of hypertensive patients, as diagnosis and subsequent treatment not only improves blood pressure control, but also acts to diminish cardiovascular morbidity and mortality. Here we present a case of a young woman with a seven-year history of hypertension prior to receiving a diagnosis of Conn's Syndrome.
authors.affiliation: Dr. Yandle is a first year fellow in the Pulmonary/Critical Care Medicine Program in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Yandle
authors.affiliation: Dr. Vonderhaar is a fourth year resident in Emergency Medicine/Internal Medicine in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Vonderhaar
authors.affiliation: Dr. Thayalakulasingam is a first year fellow in the Pulmonary/Critical Care Medicine Program in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: Theepha
authors.initials: T
authors.lastname: Thayalakulasingam
authors.affiliation: Dr. Zieske is a Co-Director, Hematopathology in the Department of Pathology and Genomic Medicine at the Methodist Hospital Physician Organization in Houston, TX.
authors.forename: Arthur
authors.initials: A
authors.lastname: Zieske
authors.affiliation: Dr. Smith is an Assistant Professor in the Department of Radiology at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Dr. Engel is an Assistant Professor in Clinical Medicine and Assistant Program Director of the Internal Medicine Residency Program in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: Lee S
authors.initials: LS
authors.lastname: Engel
authors.forename: Robert
authors.initials: R
authors.lastname: Richards
authors.affiliation: Dr. Lopez is the Richard Vial Professor and Vice Chair for Education in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Lopez
mesh_terms: D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis*; D006973:Hypertension / Q000209:etiology*; D020521:Stroke; D055815:Young Adult