Introduction: Primary aldosteronism (PA) is currently believed to be the most frequent form of secondary endocrine hypertension, accounting for 510% of all hypertensive patients. After confirming the diagnosis, adrenal venous sampling (AVS) is considered the most accurate means of distinguishing between unilateral and bilateral adrenal disease.
Case report: Female patient, 36 years-old, referred to an Endocrinology appointment in May 2009 due to left adrenal nodule and hypertension refractory to treatment. Hypertension diagnosed at age 24 with progressive drug resistance since February 2009. Left adrenal nodule known since 2004 showing an increase from 15 to 20 mm in 5 years. Family history of hypertension. On physical examination was noteworthy a blood pressure value of 210/110 mmHg. Laboratory assays showed hypokalemia (2.3 mEq/l; n: 3.55.1), increased aldosterone (ng/dl)/direct renin (μU/ml) ratio (12.6; n: 2.44.9) and negative screening for other secondary causes of hypertension. Oral potassium supplements were prescribed although with potassium levels difficult to control. Diagnosis of PA was confirmed by saline infusion test (post-infusion plasma aldosterone 62.9 ng/dl) and captopril challenge test (plasma aldosterone remained elevated and direct renin suppressed). AVS was performed but results were inconclusive. Abdominal MRI performed in July 2010 showed a 31 mm nodule in the left adrenal. Spironolactone 100 mg/day was initiated in July 2011 due to symptomatic hypokalemia. A left adrenalectomy was performed in September 2011 and spironolactone and potassium supplements were suspended in the postoperative period. Histological examination showed an adrenal adenoma. In October 2011 she presented blood pressure values of 136/83 mmHg (only medicated with verapamil) and normokalemia (4.3 mEq/l).
Conclusions: Early recognition and treatment of PA is important to overcome the high cardiovascular morbidity and mortality rates associated with this condition. PA case detection is recommended in patient groups with relatively high prevalence of the disease, such as in the clinical case described.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.