Primary hyperaldosteronism as a rare cause of hypokalemia
Küçük Resim Yok
Tarih
2020
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
National Academy of Medical Science and Ministry of Health of Ukraine
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Primary hyperaldosteronism (PHA) is a syndrome characterized by increased aldosterone release and suppressed renin-angiotensin cascade. Hypertension, alteration in potassium homeostasis, and target tissue damage are characteristic features of the disease. The importance of recognizing PHA is due to the fact that it has a very negative cardiovascular and renal effect which can result in death. In this case report, we present a patient with resistant hypokalemia whom consequently diagnosed with PHA. A 54-year-old female patient who was scheduled for operation due to congenital hip dislocation was found to have decreased serum potassium in her preoperative laboratory tests. Therefore, the patient was referred to the internal medicine outpatient clinic with a serum potassium value of 2.1 mmol/L. Her systolic and diastolic blood pressures were 150 and 90 mmHg, respectively. On electrocardiogram, prominent U waves were noted. Therefore, potassium replacement was initiated at once by intravenous route. The potassium value in spot urine was 12.4 mmol/L. A 24 hour urine collected and urinary potassium excretion in 24 hours of urine was detected as 15 mmol/L, which means transtubular potassium gradient was greater than 4 mmol/L. Since she was hypertensive during clinical follow up in the ward, hypertension along with hypokalemia raised the clinical suspicion of hyperaldosteronism. Serum aldosterone renin ratio was measured as 155 %. A computerized tomography scan revealed (22 × 16 mm) neoplasm which was suggestive of adrenal adenoma in the right adrenal gland. Cushing Syndrome was ruled out with a normal cortisol level and pheochromocytoma was ruled out by normal levels of metanephrine in the 24 hours of urine. Spironolactone 50 mg was initiated and serum potassium was raised to normal range. She scheduled for unilateral adrenalectomy and discharged with full recovery of hypokalemia. Since PHA has undesired cardiovascular and renal effects which may increase mortality and morbidity, establishing the diagnosis as soon as possible is crucial. Hypertensive patients with hypokalemia or adrenal incidentaloma or obstructive sleep apnea syndrome, resistant hypertensive subjects, patients with moderate or severe hypertension, and hypertensive patients with a family history of PHA should undergo screening for PHA. In conclusion, we suggest that PHA should be kept in mind in differential diagnosis of the patients with hypertension and hypokalemia. © 2020 National Academy of Medical Science and Ministry of Health of Ukraine. All rights reserved.
Açıklama
Anahtar Kelimeler
Hypokalemia, Primary hyperaldosteronism, Secondary hypertension
Kaynak
Problemi Endokrinnoi Patologii
WoS Q Değeri
Scopus Q Değeri
Q4
Cilt
71
Sayı
1
