Stephen Cobb's got Conn's Syndrome? Probably, but I go through Adrenal Vein Sampling(AVS) to be sure

[Updated 6/11/13: It's official, I do have Conn syndrome. The nephrologist just called to say my AVS test results were, direct quote: "Stunning!"]

This post is about my potential diagnosis of Conn syndrome and how that could lead to a healthier, more energetic life. If you have high blood pressure, dodgy heartbeat, nasty leg cramps, muscle weakness and chronic fatigue, pay attention: Conn's might be what's ailing you, and it can be cured. (This is of particular interest to anyone who has been told they have "essential hypertension", which means the doctors have essentially no idea why your BP is high.)

That fact that Stephen Cobb may have Conn syndrome is not a typo, Conn's is a medical condition first described by University of Michigan endocrinologist Jerome W. Conn in 1955. I did not have Conn's back then, but I'm pretty sure I have it now, and have had it since at least 2004. A recent CT scan revealed a growth on my left adrenal gland (we start life with two, one on each kidney). This type of growth, usually benign, is called an adenoma. Tests indicate that mine is producing the hormone aldosterone, too much of which not a good thing, as I will explain in moment.

Basically, Conn syndrome is an aldosterone-producing adenoma, and my hat is off to Dr. Conn for discovering this condition without the aid of things like CT scans. I got my doctor to order a CT scan looking for one of these adenomas because I had this quartet of symptoms:
  • High blood pressure, poorly controlled despite multiple BP meds
  • Low potassium, despite years of taking big potassium horse pills every day
  • Atrial fibrillation (as a result of the low potassium or hypokalemia)
  • Fatigue (more than just feeling tired)
If you plug these into Google you will likely see "aldosteronism" in the top results (I did this with "high blood pressure low potassium hormone" and "high blood pressure low potassium fatigue" but without the quotation marks).

Dig into these search results and you learn that aldosteronism, also called hyperaldosteronism, exists when too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood, also known as hypokalemia. An adrenal adenoma is one of a number of things that can cause primary aldosteronism. I have one on my left adrenal.

So what's the good news? If you confirm that just one of your two adrenal glands is responsible for the aldosteronism it can be surgically removed, giving your body a chance to return to normal, which appears to happen in over 50 percent of cases.
Cure of hypertension occurs in 50%–80% of patients after adrenalectomy for an aldosterone-producing adenoma, and most of the remaining cases show improvement (13,21,22). (Radiographics)
That can mean no more blood pressure pills, no more potassium pills, an end to excruciating leg cramps, a return to a regular heartbeat, more energy, even loss of excess weight, partly through being more active but also, possibly, through reduction of cortisol production (but that topic is too complex for this humble blog post).

The role of AVS

After confirming that my body was producing too much aldosterone through blood and urine tests, my primary care doctor referred me to a nephrologist who ordered Adrenal Vein Sampling (AVS) to confirm that the adenoma was the cause of this and not a general adrenal malfunction involving both glands. (You don't want an adrenal glad removed if that is not going to stop the excess aldosterone production.)

The AVS procedure is tricky, requiring interventional radiology (not invasive radiology, a term I used in error when talking to several people about this). A tube is inserted into a major vein (femoral vein in my case) and threaded to the adrenals where a series of blood samples are taken. The doctor doing this is guided by a live X-ray view of your veins using a contrast. Not only are the veins thin, but the support staff have to get things just right with the labeling of samples and so on. In other words, you want an experienced team doing this if at all possible, otherwise you don't get a result and have to go through it again.

Speaking of "going through it", you will need to set aside a day off work for AVS, followed by a day of taking it easy. That's because a. you will be given a strong anesthetic and b. you don't want the vein to pop open due to sudden movements. I went in early for mine (5:30AM) and expected to be back at work in the afternoon. Nope. Could not drive and was clearly still feeling the effects of the wonderful "twilight zone" drugs they use to sedate you (you don't go all the way under, just into a very nice place, and not at all like Twilight Zone the TV series).

I read one blogger's account of AVS before I went for mine and it was very helpful, although not exactly reassuring. Partly this was due to my (now cured) ignorance of the word "catheter" which I used to think meant only those tubes they stick into the most sensitive organs, but no, it just means any tube, in this case the one that went into my femoral vein in this procedure. To be honest, I never felt a thing.

I also read about getting shaved, but that was only a small patch of groin north of the family jewels. The prep work was mainly the shave, some blood draws, an IV for the contrast, and paperwork. The actual procedure only took about an hour and then I was required to rest horizontally for two hours to let the vein heal up. The good news is that you can eat right away (blessings on the nurse who brought me a turkey sandwich). You will likely feel hungry because you have to fast, starting at midnight the night before (no food or liquids, although you may be able to take your BP meds--ask your doctor--I didn't take mine and so BP read very high on admission, but not too high to prevent it going ahead).

How common is primary aldosteronism? A lot more common than most doctors realize. I think anyone with essential hypertension should get the basic urine and blood tests for this condition to rule it out. Although my cardiologist confessed to knowing very little about it, and both my primary care physician and the nephrologist said they have not seen it very often, consider this statement in 2009, from the The Journal of Clinical Endocrinology & Metabolism:
There is an increasing requirement for adrenal vein sampling, which is driven by the appreciation that primary aldosteronism is far more common than previously recognized (13). Many centers throughout the world are reporting a prevalence of between 5% and 10% in unselected hypertensive patients (48). 
So, check it out...and stay tuned. If I am a candidate for adrenalectomy I will describe the operation and my results for the benefit of anyone else who is going down this road.



  1. I have had these symptoms for a long time but weren't noticible for doctors to think anything about it until march when I started cramping heart flutters numbness and tingling. The dr ordered tests and right away researched the symptoms finding that it might be conns or cushings. He was very puzzled though because of my age being so young but 3 months of testing and waiting I finally saw a endocrinologist just to hear what my family doctor told me and just got another test that will take 4 weeks to get the results. I am just asking your advice on the timeline for where I am at now and if I need to seek a second opinion. Thanks you have had the clearest information yet on this "rare" syndrome/disease.

  2. [...] removing organs they no longer need? I’m thinking about this for several reasons, including my upcoming adrenalectomy and my job as a security researcher at ESET. But why do you need to think about this? Because [...]

  3. [...] Hospital on August 16, namely my left adrenalectomy. I talked about the need for this procedure in Cobb’s Got Conn’s, but not because I enjoy talking about myself. Yes, I do enjoy talking about myself, but the point [...]

  4. Dear Mr Cobb,
    I had uncontrolled hypertension from age 19-24 when they discovered my abdominal aortic dissection. It turned out I had aldosterone producing tumors on one side and cortisol on the other. I had one full and one partial adrenalectomy in hopes the partial may some day work again (2005). In 2006 at age 25 I had surgery to repair the AAA and amongst other wild complications nearly died. My partial adrenal makes aldosterone but not cortisol so I need replacement for the rest of my life. Please continue to raise awareness about hyperaldosterone. You are right, anyone with malignant hypertension should get tested! Please check me out at Did u get your gland out?

  5. Please get to another endo! I was only 19 and have irreparable damage!

  6. Please help.

    I read your blog regarding Conns syndrome and getting an adrenal vein sampling.

    Could you please tell me what doctor you went to for the AVS procedure.

    I am always chronically exhausted.

    Thank you,
    Michelle in Canton, MI

  7. I had it done here in San Diego. Will have to check his name. It was a nefrologist that make the decision to test.

  8. […] June 5, 2013: The Conn is on… Cobb’s got Conn’s? Probably, but I go through Adrenal Vein Sampling (AVS) to be sure […]

  9. Dear Mr. Cobb,
    I too have Conn's Syndrome. I too have adenomas on my left adrenal. I had the AVS, however, both of my adrenals are excessively producing too much aldosterone. I am very curious about the medical treatment with Spironolactone and if taking the medication improves my fatigue, muscle weakness and adrenal weight, gain and blurry vision.