What are the recommended management strategies for a patient diagnosed with Conn's syndrome, including pharmacological and surgical options?

Management strategies for Conn's syndrome (primary hyperaldosteronism) include both pharmacological and surgical options tailored to the underlying cause and patient characteristics.

For patients with unilateral aldosterone-producing adenoma, the recommended first-line treatment is surgical adrenalectomy of the affected adrenal gland, which can potentially cure the condition by removing the source of excess aldosterone secretion ¹. Surgery aims to normalize aldosterone levels and resolve hypertension and hypokalaemia.

In cases of bilateral adrenal hyperplasia, where surgery is not typically indicated due to the diffuse nature of the disease, pharmacological management is preferred. The mainstay of medical treatment is mineralocorticoid receptor antagonists such as spironolactone or eplerenone, which block aldosterone action and help control blood pressure and correct hypokalaemia (Faconti et al., 2024; Rossi et al., 2024).

Pharmacological therapy is also considered for patients who are not surgical candidates or who decline surgery. Spironolactone is often the first choice due to its efficacy, but eplerenone may be used if spironolactone is not tolerated due to side effects (Faconti et al., 2024).

Preoperative management includes controlling hypertension and correcting hypokalaemia to reduce surgical risk. Postoperative follow-up is essential to monitor for resolution of biochemical abnormalities and blood pressure normalization (Rossi et al., 2024).

In summary, the management of Conn's syndrome involves surgical adrenalectomy for unilateral disease and mineralocorticoid receptor antagonists for bilateral disease or non-surgical candidates, with individualized treatment plans based on diagnostic subtype and patient factors ¹; (Faconti et al., 2024; Rossi et al., 2024).