April - June 2009, Volume 5, Issue 2

Dumitrache L, Bartos D, Beuran M, Giorghe S, Tarziu C, Badila E

Primary hyperaldosteronism started by hypokalemic coma - case report

Acta Endo (Buc) 2009, 5 (2): 251-258
doi: 10.4183/aeb.2009.251

Primary hyperaldosteronism is the cause of approximately 0.05 to 2.2% of all\r\nunselected cases of hypertension. It was first described in 1955 by Conn in conjunction with\r\naldosterone-producing adrenal adenoma, which is the most frequent aetiology, in 65% of\r\ncases. Clinical features are usually non-specific and result from potassium depletion. We\r\nreport here the case of a 54-year-old woman who was admitted to the emergency department\r\ndue to coma (Glasgow score 6). The presence of severe potassium depletion (1.2 mmol/L)\r\nand metabolic alkalosis (PH=7.76, base excess>30 mmol/L) in a hypertensive patient\r\ndetermined the clinicians to search for a secondary cause of hypertension. This was\r\nconfirmed by localizing on computer tomography a right adrenal adenoma of 31-mm\r\ndiameter and on endocrine measurements that showed mineralocorticoid excess (plasma\r\naldosterone=764 pg/mL;N=14-193). Clinical evolution was slowly favourable after\r\nrestoring the electrolyte balance, with increasing of serum K up to 3.05 mmol/L. The patient\r\nbecame asymptomatic in 3 weeks and underwent laparoscopic right adrenalectomy. The\r\npatient had a good postoperatory evolution. Two weeks after laparoscopic right\r\nadrenalectomy, blood pressure normalized after the discontinuation of the antihypertension\r\ntreatment and the aldosterone measurement was normal (102 pg/mL).

Keywords: Conn disease, primary aldosteronism, secondary hypertension

Correspondence: Lacramioara Dumitrache MD, Emergency Hospital Bucharest, 8, Calea\r\nFloreasca Sector 1, Bucahrest Romania, Phone: (+4021) 599.23.00 Email: lulu74ro@yahoo.com