TY - JOUR T1 - Misdiagnosis of a hidden cause of hypertension: a case report JF - British Journal of General Practice JO - Br J Gen Pract SP - 578 LP - 579 DO - 10.3399/bjgp17X693869 VL - 67 IS - 665 AU - Andrés de Lima AU - Farah El-Sharkawy AU - Carol Nieroda AU - Armando Sardi Y1 - 2017/12/01 UR - http://bjgp.org/content/67/665/578.abstract N2 - Although essential hypertension (HTN) is the most common type of HTN, nearly 10% of patients have a secondary cause. Primary hyperaldosteronism (PHA) accounts for up to 23% of secondary HTN depending on criteria, screening methods, and the population studied.1 Aldosterone-producing adenomas, known as Conn’s syndrome, represent nearly 30% of PHA cases.Symptoms of PHA are nonspecific and may be easily missed, leading instead to the diagnosis of essential HTN. Two patients with a long history of HTN, hypokalaemia, and vague symptoms were followed by multiple specialties (internal medicine, cardiology, and endocrinology), but had not been diagnosed with Conn’s syndrome. Two cases are presented here as a means to raise awareness of this condition (Conn’s syndrome) among primary care practitioners (PCPs), because it is a potentially curable cause of HTN.A 46-year-old white female with a 6-year history of presumed essential HTN presented to her PCP with fatigue, myalgias, migraines, generalised anxiety, decreased libido, paresthesias, polydipsia, polyuria, trace peripheral oedema, heart palpitations, and shortness of breath over the previous 2 years, as well as a 1-month unexplained weight gain (3 kg). Fluctuating serum potassium levels (with the lowest of 2.1 mEq/L) were reported. Antihypertensive medications (nifedipine and hydrochlorothiazide) were deemed the cause of hypokalaemia. Oral potassium supplements and spironolactone were prescribed.A chest CT scan was unremarkable, but, incidentally, a 1.8 × 1.2 cm … ER -