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Conn syndrome • disease of the adrenal glands

Many people suffer from high blood pressure. However, the trigger does not necessarily have to be an unhealthy lifestyle. Because high blood pressure can also be caused by a disease of the adrenal glands, the so-called Conn syndrome. Read here how the disease is recognized and treated.

Conn syndrome is a disease of the adrenal glands that causes high blood pressure.
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Conn syndrome was first described by Jerome Conn in 1954. Adrenal gland disease is also known as primary aldosteronism or Conn’s disease.

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What is Conn Syndrome?

Conn’s syndrome is a disease of the adrenal glands in which the hormone aldosterone is produced to a greater extent. The most important function of aldosterone is to regulate the salt and fluid balance in the body. Overproduction of the hormone disrupts the levels of sodium and potassium in the blood, which increases the volume of fluid in the bloodstream. The result: a blood pressure that is permanently too high.

Frequency of Conn syndrome

According to the Robert Koch Institute, almost every third adult in Germany has high blood pressure (hypertension). However, it is not known how many people are affected by Conn’s disease. However, it is believed that an estimated 13 percent of adults with high blood pressure have primary aldosteronism.

The disease occurs mainly between the ages of 30 and 50. Women are affected more often than men.

Causes of Conn Syndrome

In Conn syndrome, the function of the adrenal glands is disturbed. The adrenal glands are one of the eight hormonal glands in the body, sit above the kidneys and produce over 40 hormones. The hormone aldosterone is formed in the outermost layer (zona glomerulosa) of the adrenal cortex and is part of the so-called renin-angiotensin-aldosterone system (RAAS). This hormonal system controls the water and electrolyte balance in the body and thus also influences blood pressure. If the adrenal glands produce too much aldosterone, the sodium and potassium levels in the blood are imbalanced. The result is an increased influx of water into the blood vessels and thus an increase in blood pressure.

The two most common causes of aldosterone overproduction are:

  • A benign tumor (adenoma) of the adrenal gland. The tumor forms in the glandular tissue of the adrenal cortex, produces aldosterone itself and usually occurs on one side.

  • Increased growth of both adrenal cortices, the so-called bilateral adrenal hyperplasia.

Hereditary forms of Conn’s disease occur very rarely (familial hyperaldosteronism type I and type II). Unilateral adrenal hyperplasia or an aldosterone-producing, malignant tumor on an adrenal gland are just as rare.

What are the symptoms of Conn syndrome?

The main symptoms of Conn syndrome are:

  • High blood pressure, which is difficult or impossible to control in spite of antihypertensive medication

  • Low levels of potassium in the blood

In addition, headaches, tiredness, exhaustion, muscle weakness or cramps, cardiac arrhythmias, constipation, severe thirst and increased urination can occur. Frequently, however, high blood pressure remains the only symptom of Conn’s syndrome.

However, weight gain is not a symptom of Conn’s syndrome. However, weight gain may indicate another disease of the adrenal cortex, Cushing’s syndrome.

Diagnosis and methods of investigation

Individuals can be screened for Conn syndrome, though

  • a non-adjustable high blood pressure is present,
  • Family members knowingly have primary aldosteronism or have high blood pressure at a young age (under 40)
  • an adrenal tumor was discovered by chance and you have high blood pressure.

If Conn’s syndrome is suspected, the concentration of aldosterone and renin in the blood serum is determined. Conn’s syndrome usually has aldosterone levels too high and renin levels too low. In addition, the potassium and sodium levels in the blood can also be measured to check whether the potassium level is too low.

If the laboratory results are abnormal, further examinations will take place to clarify the exact cause of Conn’s syndrome. For this, imaging methods such as computed tomography (CT) or magnetic resonance tomography (MRT) can be used. The further examinations are especially important for the distinction between adrenal adenoma and bilateral adrenal hyperplasia. Because their therapies are fundamentally different.

Treatment of Conn’s Syndrome

Depending on the cause, Conn’s disease is treated differently. If the trigger is a benign tumor, the affected adrenal gland is surgically removed. As a rule, this can cure the disease and blood pressure returns to normal.

Bilateral adrenal hyperplasia, on the other hand, is treated with medication (aldosterone antagonists such as spironolactone) that neutralize the effects of the excess aldosterone. If the blood pressure cannot be adequately regulated in this way, antihypertensive drugs are also necessary.

Prognosis and complications

After removal of an adrenal gland due to an adenoma, the healing rate, i.e. the reduction in blood pressure, is around 70 percent. However, treatable high blood pressure remains in around 30 percent of those affected. Men between the ages of 40 and 50 who have had high blood pressure for several years before the diagnosis are more frequently affected. However, there are no known prospects of recovery for those affected with bilateral adrenal enlargement. You are lifelong dependent on medication.

Conn syndrome can also lead to complications. Cardiac arrhythmias are the most common. In addition, more frequent than other forms of high blood pressure, consequential damage to the heart, kidneys, eyes, blood vessels and the central nervous system can occur. Conn’s disease sufferers therefore have an increased risk of impaired kidney function, arteriosclerosis, stroke, heart attack or retinal diseases, among other things.

Conn syndrome: exchange with other people affected

The treatment and the course of the disease are very different from person to person. Those affected who are looking for information, exchange or experience reports on the Conn syndrome of other sufferers can find support in a self-help group. Currently the only support group for patients with Conn syndrome is the Network of Pituitary and Adrenal Diseases e. V. affiliated.

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