Severe hypoaldosteronism after unilateral adrenalectomy for primary hyperaldosteronism

2017 ◽  
Author(s):  
Joao Ananias Goncalves ◽  
Rui Barrros ◽  
Betania Ferreira ◽  
Claudia Amaral
Keyword(s):  
Primary Hyperaldosteronism ◽  
Unilateral Adrenalectomy

Primary hyperaldosteronism in cats – a review

2017 ◽  
Vol XXII (127) ◽  
pp. 52-62
Author(s):  
Bruna Rodrigues Padin ◽  
Pedro Villela Pedroso Horta
Keyword(s):  
Clinical Signs ◽  
Good Prognosis ◽  
Zona Glomerulosa ◽  
The Body ◽  
Primary Hyperaldosteronism ◽  
Systemic Hypertension ◽  
Channel Blockers ◽  
Creatinine Concentration ◽  
Unilateral Adrenalectomy ◽  
Appropriate Treatment

Primary hyperaldosteronism is a disease in which tumors or hyperplasias in the zona glomerulosa of the adrenal gland induce hypersecretion of aldosterone. Effects are thus consistent with the actions of aldosterone in the body: increased sodium retention, increase of blood volume and increased renal excretion of potassium. Clinical signs are systemic hypertension and hypokalemic myopathy with generalized muscle weakness and even paresis. The most common biochemical findings are hypokalemia, elevated urea and creatinine concentration, hypomagnesemia, hypochloremia, and hypophosphatemia. Image of adrenals establishes the unilateral or bilateral involvement and the appropriate treatment for each patient. Medical treatment is symptomatic and consists of potassium supplementation, use of spironolactone and calcium channel blockers. Unilateral adrenalectomy is the treatment of choice, because it is curative and offers good prognosis.

Primary Hyperaldosteronism without Suppressed Renin Due to Secondary Hypertensive Kidney Damage

2000 ◽  
Vol 85 (9) ◽  
pp. 3266-3270 ◽  
Author(s):  
W. Oelkers ◽  
S. Diederich ◽  
V. Bähr
Keyword(s):  
Serum Creatinine ◽  
Extracellular Volume ◽  
Elevated Serum ◽  
Specific Treatment ◽  
High Plasma ◽  
Kidney Damage ◽  
Primary Hyperaldosteronism ◽  
Strong Increase ◽  
Refractory Hypertension ◽  
Unilateral Adrenalectomy

Abstract Primary hyperaldosteronism is characterized by high plasma and urinary aldosterone and suppressed PRA. Renin suppression is due to aldosterone-dependent sodium retention and mild extracellular volume expansion. We observed three patients with primary hyperaldosteronism, severe refractory hypertension, and normal to high normal PRA levels whose aldosterone/renin ratios were still elevated because of disproportionately high aldosterone levels. All available medical data on the patients as well as publications on the aldosterone/renin relationship in primary hyperaldosteronism were reviewed to explain the unusual findings. In one patient, histologically proven renal arteriolosclerosis was the probable cause of the escape of PRA from suppression by an aldosterone-producing adenoma. In the other two patients, hypertensive kidney damage due to primary hyperaldosteronism was the most likely explanation for the inappropriately high PRA, as in patient 1. All patients had high normal or slightly elevated serum creatinine levels and responded to 200 mg spironolactone/day with increased serum creatinine and hyperkalemia. Hyperkalemia was probably due to a decreased filtered load of sodium and a spironolactone-induced decrease in mineralocorticoid function. Two patients were cured of hyperaldosteronism by unilateral adrenalectomy but still need some antihypertensive therapy, whereas one patient has probable bilateral adrenal disease, with normal blood pressure on a low dose of spironolactone. In patients with severe hypertension due to primary hyperaldosteronism, PRA can escape suppression if hypertensive kidney damage supervenes. An increased aldosterone/PRA ratio is still useful in screening for primary hyperaldosteronism. These patients may respond to spironolactone therapy with a strong increase in serum creatinine and potassium. Early specific treatment of primary hyperaldosteronism is therefore indicated, and even a patient with advanced hypertension will profit from adrenalectomy or cautious spironolactone treatment.

C182 Outcomes of unilateral adrenalectomy for primary hyperaldosteronism

2013 ◽  
Vol 12 (4) ◽  
pp. e1290, C182
Author(s):  
I. Hartmann ◽  
M. Grepl ◽  
A. Vidlar ◽  
V. Student
Keyword(s):  
Primary Hyperaldosteronism ◽  
Unilateral Adrenalectomy

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.

Outcome and predictive factors of hypertension recovery after unilateral adrenalectomy for primary hyperaldosteronism

2021 ◽  
Vol 30 (1) ◽  
pp. 36-42
Author(s):  
Ibtissem Oueslati ◽  
Emna Elfaleh ◽  
Mériem Yazidi ◽  
Amel Melki ◽  
Fatma Chaker ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Primary Hyperaldosteronism ◽  
Unilateral Adrenalectomy

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 Pure aldosterone-secreting adrenocortical carcinoma in a patient with refractory primary hyperaldosteronism

2015 ◽  
Vol 2015 ◽  
Author(s):  
S Hussain ◽  
E Panteliou ◽  
D M Berney ◽  
R Carpenter ◽  
M Matson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adrenocortical Carcinoma ◽  
Primary Aldosteronism ◽  
Young Male ◽  
Scoring Systems ◽  
Primary Hyperaldosteronism ◽  
Adrenal Lesion ◽  
Resected Specimen ◽  
List Type ◽  
Unilateral Adrenalectomy

Summary We describe a young male patient with longstanding hypertension, who was diagnosed with primary hyperaldosteronism and treated by an attempted retroperitoneoscopic total unilateral adrenalectomy for a left-sided presumed aldosterone-secreting adenoma. Imaging had shown an unremarkable focal adrenal lesion with normal contralateral adrenal morphology, and histology of the resected specimen showed no adverse features. Post-operatively, his blood pressure and serum aldosterone levels fell to the normal range, but 9 months later, his hypertension recurred, primary aldosteronism was again confirmed and he was referred to our centre. Repeat imaging demonstrated an irregular left-sided adrenal lesion with normal contralateral gland appearances. Adrenal venous sampling was performed, which supported unilateral (left-sided) aldosterone hypersecretion. Redo surgery via a laparoscopically assisted transperitoneal approach was performed and multiple nodules were noted extending into the retroperitoneum. It was thought unlikely that complete resection had been achieved. His blood pressure returned to normal post-operatively, although hypokalaemia persisted. Histological examination, from this second operation, showed features of an adrenocortical carcinoma (ACC; including increased mitoses and invasion of fat) that was assessed as malignant using the scoring systems of Weiss and Aubert. Biochemical hyperaldosteronism persisted post-operatively, and detailed urine steroid profiling showed no evidence of adrenal steroid precursors or other mineralocorticoid production. He received flank radiotherapy to the left adrenal bed and continues to receive adjunctive mitotane therapy for a diagnosis of a pure aldosterone-secreting ACC. Learning points Pure aldosterone-secreting ACCs are exceptionally uncommon, but should be considered in the differential diagnosis of patients presenting with primary aldosteronism. Aldosterone-producing ACCs may not necessarily show typical radiological features consistent with malignancy. Patients who undergo surgical treatment for primary aldosteronism should have follow-up measurements of blood pressure to monitor for disease recurrence, even if post-operative normotension is thought to indicate a surgical ‘cure’. Owing to the rarity of such conditions, a greater understanding of their natural history is likely to come from wider cooperation with, and contribution to, large multi-centre outcomes databases.

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