Endocrine Abstracts (2017) 49 EP32 | DOI: 10.1530/endoabs.49.EP32

Primary aldosteronism: more common than once thought: Two clinical cases

Nadine Monteiro, Eduarda Comenda, Joana Costa, Helena Vitorino, Sofia Santos, Filipa Moleiro, Claúdia Jesus, Ana Afonso & Helena Cantante


Lusiadas, Lisboa, Portugal.


Introduction: Estimated prevalence of hypertension (HT) in Portugal is 42%. It is a major risk factor for coronary heart disease and cerebrovascular disease, the leading mortality cause in Portugal. Primary aldosteronism (PA) was once recognized as rare cause of secondary hypertension and hypokalemia a condition present in all cases. Nowadays, prevalence of this condition is about 10% in HT patients, being the commonest form of secondary HT. Secondary forms of HT should be excluded in young patients, severe increase in blood pressure, sudden onset or worsening of HT, poor blood pressure response to drugs and organ damage disproportionate to the duration of hypertension.

Case 1: A 69 years old female with a past medical history of HT for the last 20 years, presented with poor blood pressure control on bisoprolol 10 mg id perindopril 10 mg id and nifedipine 30 mg ER id at outpatient department. She had normal electrolytes. Screening tests for PA revealed high plasmatic aldosterone and suppressed renin plasmatic activity with a ratio>25 ng/ml per h. Diagnosis was confirmed after saline infusion test. CT adrenal scan suggested left adrenal diffuse hyperplasia.

Case 2: A 48 years old female presented at the emergency room complaining of severe headache and four limbs’ muscle weakness. There was a past medical history of eclampsia and hypertension diagnosed at the age of 30, and euthyroid multinodular goiter. Labs revealed hypokalemia and she was started on oral KCl 600 mg bid. After electrolytes correction, she was screened for PA. High plasmatic aldosterone and low renin plasmatic concentration with a ratio>3.8 was detected. Diagnosis was confirmed after saline infusion test.

Conclusion: PA is an important cause of secondary hypertension, with a higher cardiovascular event rate than essential hypertension. It is frequently underdiagnosed and a potentially curable form of hypertension.

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