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(Hypertension. 2008;52:e23.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Response to Delay in the Diagnosis of Conn’s Syndrome: A Single-Center Experience Over 30 Years

Dipartimento di Medicina Cliniçae Sperimentale-Clinica Medica 4, University of Padua, Padua, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Dhanjal and Beevers¹ raised some interesting issues concerning our study on predictors of outcome in aldosterone-producing adenoma (APA) patients postadrenalectomy. Consistent with our findings, they also found that a long known duration of hypertension was common before APA could be diagnosed and treated by adrenalectomy. Interestingly, they noticed that this long duration, 8 years, before undertaking adrenalectomy was mainly because of the delay in referring the hypertensive patients from the primary care setting to the tertiary centers. This observation accords well with our data: the average time from referral to adrenalectomy in our APA cases was 6 months, and, therefore, most of the known duration of hypertension can be attributed to a delayed suspicion of primary aldosteronism and/or a delayed referral to a tertiary center.

Moreover, this is not at all surprising, because primary aldosteronism, albeit being the most common endocrine cause of hypertension, often masquerades itself as "essential hypertension," as Conn et al² pointed out many years ago. Data obtained in hypertensive patients screened by general practitioners in the Bussolengo Study suggested a high prevalence of primary aldosteronism at the primary care setting³; more recently this high prevalence was demonstrated in the Prevalence of Primary Aldosteronism in Hypertension Study, the largest prospective investigation of referred hypertensive subjects, where 4.8% of 1125 consecutive patients were eventually confirmed to have an APA.⁴ This study also testified the difficulty of suspecting the diagnosis, because the majority of the patients eventually confirmed to have an APA had neither hypokalemia nor severe/resistant hypertension . . . [Full Text of this Article]