Endocrine Abstracts

Introduction: Primary aldosteronism is characterized by hypertension and accounts for about 10% of hypertensive patients. Post-operative hypoaldosteronism is well documented in cases within the past 3 years of unilateral adrenalectomy for aldosterone-producing adenomas.

Case report: We present the case of a 46-year-old patient with a 10-year history of hypertension and hypokalaemia (1.9 mmol/l) with normal renal function. Serum aldosterone was high with low renin activity leading to high aldosterone to renin ratio. Serum creatinine was 67 umol/l. CT abdomen showed 1.5 cm hypodense left adrenal mass. Post unilateral adrenalectomy he had reduction in the blood pressure, became eukalemic. After 8 weeks of adrenalectomy patient developed hyperkalemia (6.4 mmol/l) and increased serum creatinine (161 umol/l). Nephrology was recommended furosemide 80 mg daily. After furosemide, his kalium dropped to 5.8 mmol/l, creatinine to 149 umol/l. After 9 weeks, he presented to our department with muscle cramps, weakness, intermittent cardiac arrhythmia, and hyperkalemia (6.2 mmol/l), hypocalcaemia (1.82 mmol/l), hyperphosphatemia (1.9 mmol/l), the serum creatinine (158 umol/l) and parathyroid hormone (135 pg/ml) were high, aldosterone (16.3 pg/ml) and 25(OH)D (11.4 ng/ml) were low. After fluid resuscitation he was started on fludrocortisone 0.1 mg, calcium carbonate 1500 mg daily, and cholecalciferol 50.000IU weekly. His furosemide was reduced to 20 mg in a day. Two weeks later his creatinine was 126 umol/l,kalium 5.3 mmol/l, calcium 2.2 mmol/l, phosphat 1.6 mmol/l. His blood pressure was 138/85;therefore, he was switched to furosemide 20 mg once daily. Two months later his serum creatinine was 109 umol/l, kalium 4.8 mmol/l, calcium 2.31 mmol/l, phosphat 1.35 mmol/l, parathyroid hormone 83 pg/ml, 25(OH)D 29.1 ng/ml and so a dose reduction in fludrocortisone was attempted but at 0.05 mg per day, her kalium promptly rose to 5.2 mmol/l with creatinine 118 umol/l. The furosemide was stopped and fludrocortisone dose increased again with similar normalization of kalium and creatinine. Two months later off of the fludrocortisone 0.1 mg, his blood pressures were 145/85 and a dose reduction in fludrocortisone was attempted again. During the last 5 weeks on fludrocortisone 0.05 mg daily andcholecalciferol 10.000 IU weekly, his blood pressures (120–130/70-75), kalium (4.9–5.0 mmol/l),calcium (2.34 mmol/l),parathyroid hormone (54 pg/ml) have been normal with stable renal function (creatinine 100–103 umol/l).

Conclusion: Screening of developing post-operative hypoaldosteronism with hyperkalemia should be actively considered in high-risk patients.