When should I consider referring a patient with suspected Conn's syndrome to a specialist for further evaluation?

Consider referring a patient with suspected Conn's syndrome (primary hyperaldosteronism) to a specialist (endocrinologist) for further evaluation if:

• They have resistant hypertension, especially if blood potassium is low or normal despite treatment.
• There is hypertension with spontaneous or diuretic-induced hypokalaemia.
• They have an adrenal incidentaloma with hypertension.
• Screening tests (such as aldosterone-renin ratio) are abnormal or clinical suspicion remains high despite normal initial tests.
• They require further investigation for secondary causes of hypertension or consideration of specific treatment options like surgery or mineralocorticoid receptor antagonists.

Referral is important because specialist assessment is needed for confirmatory testing, subtype differentiation (e.g., adrenal adenoma vs bilateral hyperplasia), and management planning.