Conn's Syndrome

Conn’s syndrome did not arrive as a diagnosis. It arrived as a slow, illogical sequence of events and odd symptoms

At the time, I was living in the United States. It was the start of the pandemic, and I had just had my second child after an unremarkable pregnancy. I relocated from the East coast to the West, a place with no friends or support network.

My annual physical fell around nine months after the birth - hardly an unusual point to feel exhausted

The appointment should have been routine. Instead, my blood pressure was alarmingly high.

This caused confusion. I did not fit their profile. I was slim, active, a non-smoker, rarely drank alcohol.

I was advised to “do more yoga” and prescribed Lisinopril.

This is one of those moments that sounds mildly absurd in retrospect, but at the time felt plausible enough to follow.

At each subsequent appointment, my blood pressure increased. The solution was consistent: increase the medication dose until the maximum was reached. There was no clear explanation, but also no escalation. I looked well, so was effectively too healthy-looking to investigate properly.

Meanwhile, I was rapidly declining

This went far beyond the expected fatigue of two young children and a cross-country relocation in a pandemic. My body felt as though it was running two conflicting systems at once—one foot on the brake and the other on the accelerator. I couldn’t sleep, but I also couldn’t function. My heart would beat with extreme force, as though it had developed its own agenda. Simple tasks where like endurance challenges.

There is a particular frustration in knowing something is wrong while being told, repeatedly, that it isn’t.

Eventually, I moved to Portugal.

By this point, I had accepted—somewhat reluctantly—the idea that I simply had unexplained high blood pressure. I went to fill my prescription expecting continuity.

Instead, I encountered a system that was, if nothing else, more curious.

The assumption was questioned almost immediately.

Within a week, I had a cardiac ultrasound. It showed structural changes that required explanation. I was asked whether I regularly did triathlons. This was not a question I had anticipated. The alternative interpretation was less flattering: that my heart had been under sustained strain for some time.

I suggested stress, cautiously, via Google Translate—my Portuguese at the time was not equipped for nuance.

This theory was dismissed with impressive efficiency.

An adrenal scan was ordered.

It identified a tumour on my right adrenal gland.

The endocrinologist delivered the diagnosis with a level of interest that was almost refreshing. There was, unmistakably, a degree of professional curiosity. The condition had a name: Conn’s syndrome.

She mentioned, with a small amount of enthusiasm, that she had not personally encountered a case before. I had already been discussed with a panel of specialists. The probability of being suitable for surgery was estimated at around 30%, and the procedure itself was not routinely performed in Portugal.

It was, in many ways, both reassuring and slightly disconcerting to be medically interesting.

The immediate plan was pragmatic.

I was prescribed Spironolactone to counteract the hormonal effects driving the condition. There were clear instructions: maintain a low- to no-salt diet, or the medication would be significantly less effective. Monitoring would be regular.

The contrast with the previous experience was notable. The problem was now defined, measurable, and being actively managed.

It turns out there is a significant difference between being told nothing is wrong—and finding out, quite precisely, what is