scholarly journals SAT-LB301 Hyperaldosteronism From Adrenal Adenoma in a Young Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Francisco Javier Lopez Maldonado ◽  
Angel Alfonso Mayorga León ◽  
Alondra Rodriguez Gonzalez ◽  
Eduardo Rafael León Milán ◽  
Carlos Alfonso Morales Chinchillas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Symptoms ◽  
Adrenal Adenoma ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Blurred Vision ◽  
Plasma Aldosterone Concentration ◽  
Unilateral Adrenalectomy ◽  
Blood Pressure Elevation ◽  
Cardiovascular Morbidity And Mortality

Abstract Introduction Primary aldosteronism (PA) is the most common cause of secondary hypertension (HTN) that is often underdiagnosed. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex- matched patients with essential HTN and the same degree of blood pressure elevation. We present a case of a 17-year old male with primary hyperaldosteronism. Case Report 17-year-old male with no past medical history presented to the emergency department referring bitemporal cephalea, pain in left arm, dyspnea, heart palpitations, a blood pressure (BP) of 220/110 mmHg and a serum potassium of 1.5mmol/L (n. 3.5-5). The patient was admitted to the hospital for better handling of his BP, potassium repositions, monitoring and further management. During hospitalization he referred leg cramps, asthenia, adynamia, nausea, cephalea, and blurred vision. Physical examination demonstrated decreased muscle strength, jugular regurgitation II and hyperreflexia on lower extremities. Thyroid and pulmonary examinations were normal. BP continued elevated despite the concurrent use of 3 antihypertensive drug classes (ARA2, BB, CCB), referred to endocrinologist after being diagnosed with resistant hypertension suspecting of a primary hyperaldosteronism. Lab tests were run obtaining a plasma aldosterone concentration 44ng/dl (n. 4-31), plasma active renin (PRA) 0.05ng/ml/hr (n. 0.2-1.6), aldosterone/PAR ratio 880 (<25 normal). Suprarenal CT scan revealed right suprarenal lesion 2.2 x 2.1 cm, round appearance, hypodense (14 HU) compatible with an adenoma. He underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor was compatible with a benign adenoma. Patient was discharged with a regularized blood pressure without antihypertensives and normokalemic. No clinical symptoms were reported in follow-up. ConclusionPrimary aldosteronism (PA) is the most common form of secondary hypertension (HTN) with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. PA is characterized by hypertension, hypokalemia, suppressed plasma renin and increased aldosterone excretion. Aldosterone producing adenomas (APAS) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The most sensitive screening test for PA is the aldosterone-to-renin ratio. After case confirmation, all patients with PA should undergo adrenal CT as the initial study. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist.

scholarly journals Primary hyperaldosteronism- a resistant endocrine hypertension- A case report

2009 ◽  
Vol 4 (2) ◽  
pp. 49-50
Author(s):  
Syed Ali Ahsan ◽  
Md Rubayat Rahman ◽  
Mohammad Salman ◽  
Md Ashraful Haque ◽  
Ahmed Saiful Bari ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Post Partum ◽  
Adrenal Adenoma ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Primary Hyperaldosteronism ◽  
Uncontrolled Hypertension ◽  
Unilateral Adrenalectomy ◽  
Endocrine Hypertension

 A thirty years old lady presented with uncontrolled hypertension and dizziness during working for last 5 years. She had history of termination of pregnancy due to treatment-resistant hypertension. Even in the post-partum period her blood pressure remains uncontrolled with more than three antihypertensive drugs. Her serum K+ level was low and USG of KUB & adrenal glands showed slightly increased right renal cortical echotexture; CT scan of abdomen revealed right Adrenal adenoma. She underwent unilateral adrenalectomy. Now, she has no complaints and her blood pressure is normal without any antihypertensive drugs. There is no target organ damage. Key words: Primary hyperaldosteronism, unilateral adrenal adenoma, resistant endocrine hypertension   doi:10.3329/uhj.v4i2.2077 University Heart Journal Vol. 4 No. 2 July 2008 p.49-50

Normal Blood Pressures and the Evaluation of Sustained Blood Pressure Elevation in Childhood: The Muscatine Study

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Linda K. Rames ◽  
William R. Clarke ◽  
William E. Connor ◽  
Mary Ann Reiter ◽  
Ronald M. Lauer
Keyword(s):  
Blood Pressure ◽  
Predominantly White ◽  
Secondary Hypertension ◽  
School Age Children ◽  
Continuing Care ◽  
School Age ◽  
Blood Pressure Elevation ◽  
Pressure Distributions ◽  
Blood Pressures ◽  
Transient Elevation

This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.

Secondary Hypertension in Children and Adolescents: Novel Insights

2020 ◽  
Vol 16 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Katerina Chrysaidou ◽  
Athanasia Chainoglou ◽  
Vasiliki Karava ◽  
John Dotis ◽  
Nikoleta Printza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Children And Adolescents ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Pressure Monitoring ◽  
Cardiovascular Morbidity And Mortality ◽  
Rising Incidence ◽  
Hypertension In Children

Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

Nutritional management of hypertension: controversies and frontiers Proceedings of one more meeting?

1986 ◽  
Vol 64 (6) ◽  
pp. 770-771
Author(s):  
Frans H. H. Leenen
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Side Effects ◽  
Antihypertensive Therapy ◽  
Mild Hypertension ◽  
Severe Hypertension ◽  
Nutritional Management ◽  
Blood Pressure Elevation ◽  
Cardiovascular Morbidity And Mortality ◽  
Treatment Of Hypertension

In recent years antihypertensive therapy has evolved from treatment for a relatively small number of patients with severe hypertension to treatment for millions of people with mild to severe hypertension. We now treat not only patients at high risk for future cardiovascular morbidity and mortality, of whom nearly all are benefitting from antihypertensive therapy, but also much larger groups of patients each individually at low risk. In this latter group only a small percentage actually benefits from antihypertensive therapy. For example, in the Australian trial in subjects with mild hypertension and no other evidence of cardiovascular disease, only two excess deaths were prevented at the expense of 1000 patient-years of drug treatment (Australian Therapeutic Trial 1980). For most individual members of this group normalizing their mild blood pressure elevation appears to offer no benefit, yet all of them are exposed to antihypertensive therapy and its side effects. When instituting antihypertensive pharmacotherapy in patients with mild hypertension one has to be concerned about these side effects, not just the objective ones (e.g., effects on plasma lipoproteins or glucose which may offset any gains to be obtained by lowering blood pressure), but also subjective ones (e.g., fatigue, impotence) which may markedly affect the quality of life.Nonpharmacologic, in particular nutritional, management of mild hypertension has intuitively major appeal for "lowering blood pressure without side effects." Many studies have evaluated the effects of dietary changes on blood pressure. Several recent symposia have addressed the issue of nutrition and hypertension. Despite this, the report from the first Consensus Development Conference of the Canadian Hypertension Society ("on the management of mild hypertension in Canada") states "Because of conflicting evidence and problems with patient compliance, the conference had difficulty reaching consensus on the effectiveness of salt restriction and, for the obese, of weight reduction in lowering blood pressure" (Logan 1984).This issue of the Canadian Journal of Physiology and Pharmacology contains the proceedings of a workshop "Nutritional Management of Hypertension: Controversies and Frontiers," held in Harrison Hot Springs, British Columbia, September 6–7, 1985. This workshop was organized under the auspices of the Canadian Hypertension Society and made possible by generous financial support from ICI Pharma, Canada (general sponsorship) as well as from the National Institute of Nutrition for the obesity session, and from the Dairy Bureau of Canada for the sodium–calcium session.To define more clearly the controversies and uncertainties, this workshop was organized in a different way than previous meetings dealing with this issue. A clinical scientist working in a particular area was invited to outline the evidence in favour of a given dietary manipulation for the treatment of hypertension, and another one to outline the evidence against. This evaluation would particularly concern evidence regarding "efficacy" and "effectiveness". A discussant then presented an evaluation of the two position papers, followed by a general discussion and a summary by the session chairman. This type of scrutiny of our current knowledge was done for sodium restriction, calcium supplementation, and weight loss. As part of this evaluation two speakers addressed the closely related issues of practical aspects of diet management (e.g. compliance) and the consequences–risks of weight loss in relation to the pathophysiology of obesity.In the last part of the workshop possible future developments in nutrition and hypertension were reviewed, such as "nutrition in the young, early intervention?," vegetarian approach to hypertension, role of dietary fats, and proteins and precursors.The organizing committee very much appreciated that Dr. David Sackett was willing to serve as the scientific chairman of this workshop, to summarize the present "state of the art" on diet modulation in the management of hypertension as well as to propose recommendations for treatment of hypertension in clinical practice and for future research directions.It was a pleasure for me to serve as chairman of the organizing committee. As President of the Canadian Hypertension Society I would like to thank all session chairmen, speakers, discussants, and participants for their enthusiasm and eagerness to explore the topic of nutrition and hypertension. I hope that the scientific information and insight that the proceedings of this workshop offer will convey their commitment.

Primary hyperparathyroidism associated with primary hyperaldosteronism

1983 ◽  
Vol 103 (3) ◽  
pp. 365-370 ◽  
Author(s):  
J. B. Ferriss ◽  
J. J. Brown ◽  
A. M. M. Cumming ◽  
R. Fraser ◽  
A. F. Lever ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Adrenal Adenoma ◽  
Plasma Renin ◽  
Ct Scanning ◽  
Plasma Potassium ◽  
Renal Calculi ◽  
Primary Hyperaldosteronism ◽  
Prolonged Treatment

Abstract. Two patients with both primary hyperparathyroidism and primary hyperaldosteronism are described. Each presented with high blood pressure and a history of renal calculi. Mild hypercalcaemia was associated with raised plasma parathyroid hormone concentrations and a parathyroid adenoma was excised from each. Both patients also had hypokalaemia, hyperaldosteronism and low plasma renin concentrations. Quadric analysis, adrenal vein plasma aldosterone concentrations, adrenal venography and CT scanning all suggested an adrenal adenoma in each patient. This suspicion was confirmed at operation in one patient; the other patient is unfit for adrenal surgery but her blood pressure and plasma potassium concentration have remained within the normal range during prolonged treatment with either spironolactone or amiloride. Because of this unusual association a search was made for parathyroid hormone excess in patients with primary hyperaldosteronism and for aldosterone excess in primary hyperparathyroidism. None was found.

scholarly journals Coexistence of Primary Hyperaldosteronism and Graves’ Disease, a Rare Combination of Endocrine Disorders: Is It beyond a Coincidence—A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
S. S. C. Gunatilake ◽  
U. Bulugahapitiya
Keyword(s):  
Case Report ◽  
Adrenal Adenoma ◽  
Underlying Mechanism ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Endocrine Disorders ◽  
Sri Lankan ◽  
Underlying Mechanisms

Background. Primary hyperaldosteronism is a known cause for secondary hypertension. In addition to its effect on blood pressure, aldosterone exhibits proinflammatory actions and plays a role in immunomodulation/development of autoimmunity. Recent researches also suggest significant thyroid dysfunction among patients with hyperaldosteronism, but exact causal relationship is not established. Autoimmune hyperthyroidism (Graves’ disease) and primary hyperaldosteronism rarely coexist but underlying mechanisms associating the two are still unclear.Case Presentation. A 32-year-old Sri Lankan female was evaluated for new onset hypertension in association with hypokalemia. She also had features of hyperthyroidism together with high TSH receptor antibodies suggestive of Graves’ disease. On evaluation of persistent hypokalemia and hypertension, primary hyperaldosteronism due to right-sided adrenal adenoma was diagnosed. She was rendered euthyroid with antithyroid drugs followed by right-sided adrenalectomy. Antithyroid drugs were continued up to 12 months, after which the patient entered remission of Graves’ disease.Conclusion. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist and this case report adds to the limited number of cases documented in the literature. Underlying mechanism associating the two is still unclear but possibilities of autoimmune mechanisms and autoantibodies warrant further evaluation and research.

scholarly journals Primary hyperaldosteronism: difficulties in diagnosis

2019 ◽  
Vol 91 (10) ◽  
pp. 91-99
Author(s):  
B M Shifman ◽  
N M Platonova ◽  
N V Molashenko ◽  
E A Troshina ◽  
I I Sitkin ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Secondary Hypertension ◽  
Standard Test ◽  
Clinical Syndrome ◽  
Primary Hyperaldosteronism ◽  
Venous Sampling ◽  
Hormone Production ◽  
Unilateral Adrenalectomy ◽  
Gold Standard Test ◽  
Hyperplastic Tissue

Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.

scholarly journals Insuficiencia mineralocorticoide posterior a adrenalectomía unilateral como tratamiento para hiperaldosteronismo primario: Reporte de un caso

2017 ◽  
Vol 3 (4) ◽  
pp. 29-31
Author(s):  
María Inés Toro Grajales ◽  
Juan Guillermo Sarmiento Ramón ◽  
Juan Camilo Sarmiento Ramón ◽  
Mariana Izquierdo ◽  
Silvia Natalia Gutiérrez ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Adrenal Adenoma ◽  
Kidney Injury ◽  
Primary Hyperaldosteronism ◽  
Antihypertensive Medications ◽  
Unilateral Adrenalectomy ◽  
Adequate Response ◽  
Factores De Riesgo ◽  
History Of ◽  
Adrenal Ct

Introducción: El hiperaldosteronismo primario es la causa más frecuente de hipertensión de origen endocrino. Presentamos una insuficiencia de mineralocorticoides como complicación posterior a adrenalectomía unilateral.Presentación del caso: Paciente femenina de 51 años, con historia de larga data de hipertensión resistente, hospitalizaciones por hipopotasemia y enfermedad renal crónica hipertensiva. Se confirmó hiperaldosteronismo primario con valores altos de aldosterona e indetectables de renina. La TAC de adrenales mostró un adenoma derecho de 23 mm. Dado el cuadro clínico severo y valores bioquímicos, se llevó directamente a adrenalectomía derecha. Posterior al procedimiento retiran todos los antihipertensivos; sin embargo, la paciente presenta hipotensión, deterioro de la función renal e hiperpotasiemia con valores de aldosterona y renina inapropiadamente normales. Se inició manejo con hidratación y fludrocortisona, presentando adecuada respuesta con normotensión, potasio y azoados normales.Discusión: La insuficiencia de mineralocorticoides es una complicación poco conocida, aunque frecuente posterior adrenalectomía por hiperaldosteronismo, cursa con hiperpotasiemia, hipotensión y deshidratación. Son factores de riesgo un hiperaldosteronismo severo, de larga data y falla renal. Requiere manejo con fludrocortisona, usualmente de manera transitoria durante semanas a meses.Conclusión: Se deben vigilar signos de hipoaldosteronismo posterior a la adrenalectomía por hiperaldosteronismo primario, dado que hasta un tercio de pacientes puede presentar insuficiencia de mineralocorticoides.Abstract Introduction: Primary hyperaldosteronism is the most frequent endocrine cause of hypertension. We present the case of a patient with mineralocorticoid insufficiency secondary to unilateral adrenalectomy. Case report: 51 year-old female with a long-standing history of resistant hypertension, multiple admissions due to hypokalemia and chronic kidney disease secondary to hypertension. High aldosterone levels and undetectable renin levels confirmed the diagnosis of primary hyperaldosteronism. Adrenal CT scan showed a 23-mm right adrenal adenoma. Given the severe presentation and confirmatory laboratory results, the patient underwent right adrenalectomy. After the surgical intervention, all antihypertensive medications were withdrawn, but later on, the patient presented hypotension, acute kidney injury and hyperkalemia with inappropriately normal aldosterone and renin levels. Intravenous fluids and fludrocortisone were started with adequate response given by normal blood pressure, normal potassium levels and normal kidney function. Discussion: Mineralocorticoid insufficiency is not a very well-known, although frequent, complication of adrenalectomy secondary to hyperaldosteronism. Patients present with hyperkalemia, hypotension and dehydration. Risk factors for developing mineralocorticoid insufficiency include severe hyperaldosteronism, long-standing hyperaldosteronism and kidney failure. Its management requires the transient use of fludrocortisone for weeks to months. Conclusion: Signs of aldosterone insufficiency must be followed after adrenalectomy secondary to primary hyperaldostornism, given that up to one third of patients may present with mineralocorticoid insufficiency.

scholarly journals In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism

2020 ◽  
Vol 16 (4) ◽  
pp. 557-563
Author(s):  
O. V. Tsygankova ◽  
T. I. Batluk ◽  
L. D. Latyntseva ◽  
E. V. Akhmerova ◽  
N. M. Akhmedzhanov
Keyword(s):  
Adrenal Adenoma ◽  
Renin Angiotensin System ◽  
Correct Choice ◽  
Secondary Hypertension ◽  
Diagnostic Methods ◽  
Primary Hyperaldosteronism ◽  
Refractory Hypertension ◽  
Aldosterone Production ◽  
Surgical Tactics ◽  
Saline Test

Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.

scholarly journals Role of Nox2 and p22phox in Persistent Postoperative Hypertension in Aldosterone-Producing Adenoma Patients after Adrenalectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Xiaojing Geng ◽  
Li Yan ◽  
Jun Dong ◽  
Ying Liang ◽  
Yajuan Deng ◽  
...  
Keyword(s):  
Nadph Oxidase ◽  
Secondary Hypertension ◽  
Zona Glomerulosa ◽  
Catalytic Core ◽  
Plasma Aldosterone Concentration ◽  
Unilateral Adrenalectomy ◽  
Protein Levels ◽  
Aldosterone Producing Adenoma

Adrenal aldosterone-producing adenoma (APA), producing the salt-retaining hormone aldosterone, commonly causes secondary hypertension, which often persists after unilateral adrenalectomy. Although persistent hypertension was correlated with residual hormone aldosterone, thein vivomechanism remains unclear. NADPH oxidase is the critical cause of aldosterone synthesisin vitro. Nox2 and p22phox comprise the NADPH oxidase catalytic core, serving to initiate a reactive oxygen species (ROS) cascade that may participate in the pathology. mRNAs of seven NADPH oxidase isoforms in APA were evaluated by RT-PCR and Q-PCR and their proteins by immunohistochemistry and Western blotting. NADPH oxidase activity was also detected. Nox2 and p22phox were especially abundant in APA. Particularly higher Nox2 and p22phox gene and protein levels were seen in APA than controls. Significant correlations betweenNox2mRNA andaldosterone synthase (CYP11B2)mRNA (R=0.66,P<0.01) and Nox2 protein and baseline plasma aldosterone concentration (PAC) (R=0.503,P<0.01) were detected in APA; however, none were found betweenp22phoxmRNA,CYP11B2mRNA,p22phoxprotein, and baseline PAC. Importantly, we found that Nox2 localized specifically in hyperplastic zona glomerulosa cells. In conclusion, our results highlight that Nox2 and p22phox may be directly involved in pathological aldosterone production and zona glomerulosa cell proliferation after APA resection.

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