What is the most common treatment for Conn's syndrome?

• A. Medical therapy with spironolactone
• B. Surgery for possible tumors after imaging with Captopril and PA/PRA
• C. Radiation therapy
• D. Observation only

Answer: (B)

Conn's syndrome is a form of primary hyperaldosteronism where one adrenal gland usually makes excess aldosterone. When the excess is coming from a unilateral lesion, removing that adrenal gland is the definitive treatment. This is why, after confirming autonomous aldosterone production (often using PA/PRA testing and a captopril challenge) and localizing a unilateral tumor on imaging, the standard approach is surgical removal of the affected adrenal gland. Laparoscopic adrenalectomy can cure or greatly improve blood pressure and potassium balance in many patients.

Medical therapy with spironolactone or eplerenone is used when the disease is bilateral (or surgery isn’t possible), to block aldosterone’s effects rather than remove the source. Radiation therapy isn’t a treatment for Conn's syndrome, and observing without intervention isn’t appropriate because ongoing aldosterone excess harms blood pressure and potassium homeostasis.