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High Blood Pressure: New Test Accurately Diagnoses Conn’s Syndrome

One in twenty cases of high blood pressure is thought to be caused by Conn’s Syndrome or primary hyperaldosteronism.  This is a disease of the adrenal glands that sit above the kidneys. Until now it has been difficult to detect, requiring a complex series of tests on blood taken from a vein supplying the adrenal gland. The development of a test using a PET-CT scan that can accurately diagnose the syndrome has changed that, which is good news because Conn’s Syndrome is most common curable cause of hypertension.

What is Conn’s Syndrome?

It is the excess secretion of the hormone aldosterone into the blood is from an abnormal adrenal gland or glands. Two types of abnormality are seen: a benign tumour of one adrenal, called an adenoma or a general enlargement of both adrenals, called hyperplasia. The underlying reasons for the development of an adenoma or hyperplasia are not known.

What are the symptoms?

High blood pressure (hypertension) is the main, and often the only, symptom. Other symptoms may occur because high aldosterone levels in the blood act on the kidney to increase the loss of the mineral potassium in the urine. This in turn may lead to a fall in blood potassium, resulting in tiredness, muscle weakness and passing of large volumes of urine (polyuria), especially at night (nocturia).

However, these symptoms are also found in many other conditions (for example, diabetes mellitus or hypercalcaemia) and do not, by themselves, establish a diagnosis of Conn’s syndrome.

Also, many patients with proven Conn’s syndrome do not have a low blood potassium level.

How is it diagnosed?

Until now, it has been difficult to detect, requiring a complex series of tests on blood taken from a vein supplying the adrenal gland. All that has changed with the development test using a PET-CT scan that can accurately diagnose the condition.

How does the new test work?

The PET-CT scan looks for small growths in the adrenal glands that are about 17mm across. These benign growths or tumours, called adenomas, give out excessive amounts a hormone called aldosterone, which in turn raises blood pressure. The research team at the University of Cambridge developed a radioactive tracer called 11C-metomidate, which lights up culprit adenomas in the scan.

The new test could be especially important for older patients in whom growths in the adrenal glands are often seen in routine CT scans. Often, these growths are not a sign of Conn’s Syndrome. Up to now it has been difficult to be sure and that causes anxiety for the patient. So, making the correct diagnosis is very important.

Cure or management

Once the problem is identified the condition can be treated either by surgically removing the affected gland or by using a drug to block the effects of aldosterone. Correctly treating the condition is important because the high blood pressure it causes greatly increases the risk of heart attack and stroke. If, however, your hypertension is not due to this cause, there is no cure – only management of your high blood pressure.

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