April - June 2010, Volume 6, Issue 2

Constantinescu M, Bartos D, Grigorie D, Ghiorghe S, Badila E, Tarziu C

Persistent hypertension associated with hypokalemia and hypothyroidism

Acta Endo (Buc) 2010, 6 (2): 257-261
doi: 10.4183/aeb.2010.257

Background. The association between high blood pressure and hypokalemia is usually caused by primary or secondary hyperaldosteronism. Recent studies indicate that\r\nprimary hyperaldosteronism is a much more common cause of hypertension than had been previously demonstrated. Arterial hypertension is often present in hypothyroid patients, but almost never associated with hypokalemia.\r\nCase report. We report the case of a 69 years old male admitted for shortness of breath, inferior limbs edema and fatigue. From his medical history we mention: essential\r\narterial hypertension (for about 25 years), ischaemic coronary artery disease (for 20 years), for which he underwent PTCA (two years ago), atrial fibrillation electrically converted to sinus rhythm (a year a ago). Despite taking four antihypertensive drugs his blood pressure was far from being controlled. Blood analysis revealed an important hypopotasemia (K 2.4mmol/l) and consequently the loop diuretic was replaced with a potassium-sparing diuretic. The measured proved to be unsuccessful and potassium supplements had to be\r\nadded, but with modest results (K 2.94mmol/l). Further specific investigations revealed almost normal levels of aldosteron, low renin, normal cortisol. Associated was a high Thyroid-stimulating hormone (TSH). Computer tomografy (CT) showed bilateral suprarenal glands adenomas.\r\nConsidering the laboratory findings, we interpret the case as a primary hyperaldosteronism and a successful treatment with spironolactone was initiated.

Keywords: Hypertension, hypokalemia, hypothyroidism, cortisol

Correspondence: M. Constantinescu MD, Emergency Hospital Bucharest, Dpt. of Internal Medicine, 8 Floreasca, Bucharest 014461, Romania, Tel: +40215992308. Email: mihaela_constantinescu_ms@yahoo.com