Snapshot A 27-year-old male present with headaches, muscle weakness, and high blood pressure. Labs showed a Na of 151 and K of 3.1. CT of the abdomen showed an adrenal mass. Introduction 70% of cases are caused by unilateral adrenal adenoma (Conn's Syndrome) The remaining 30% are caused from bilateral adrenal hyperplasia of zona glomerulosa Epidemiology twice as common in women then men usually between the ages of 30-50 Presentation Symptoms hypertension (secondary to increased plasma volume secondary to increased sodium reabsorption) Suspect the diagnosis in patients with resistant hypertension who develop severe hypokalemia after initiation of a thiazide diuretic (such as HCTZ) headache polyuria (secondary to hypokalemic nephropathy) muscle weakness (secondary to hypokalemia) Physical exam tetany (hypokalemia) parestesias peripheral edema in severe cases Evaluation Labs hypokalemia hypernatremia low plasma renin (neg. regulation by high aldsterone) elevated 24-hour urine aldosterone metabolic alkalosis (dumping H+ for Na+) Obtain imaging to look for adrenal or pituitary mass Differential Essential hypertension, diuretic toxicity, nephrogenic diabetes insipitus, secondary hyperaldosteronism (renal artery stenosis, CHF, cirrhosis, and anything else that elevates renin levels) Treatment Beta blockers or diuretic for hypertension Surgical adrenalectomy for adenoma bilateral adrenalectomy should not be performed Spirolactone (aldosterone receptor antagonist) for bilateral adrenal hyperplasia