ACTA ENDOCRINOLOGICA (BUC)

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).

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.