Intraoperative Hypertensive Crisis in a Patient with Normotensive Primary Aldosteronism. Lessons from a Clinical Case
Cardiology and Angiology: An International Journal,
Page 1-7
DOI:
10.9734/ca/2019/v8i430107
Abstract
Primary hyperaldosteronism is the most frequent cause of secondary hypertension. However, it can also be found in apparently normotensive patients, often associated with recurrent hypokalemia and isolated hypertensive episodes.
We hereby present the case of a normotensive 50-year-old female patient with a surgical left kidney mass; however, after anaesthetic induction, surgery was aborted due to a severe hypertensive crisis. She was referred to our Hypertension Outpatient Clinic to rule out pheochromocytoma/ paraganglioma. The anamnesis revealed unexplained episodes of hypokalemia. Ambulatory blood pressure monitoring showed normal mean values of blood pressure and heart rate, with an isolated hypertensive peak. Plasma glucose, ions, creatinine, lipids, metanephrines and chromogranin A were normal, but plasma aldosterone was clearly elevated with suppressed plasma renin activity and high aldosterone/renin activity ratio. Primary aldosteronism was confirmed by the captopril test. Abdominal CT was compatible with left adrenal hyperplasia. Treatment with low-dose spironolactone was well tolerated and resulted in normal blood pressure, normokalemia and unsuppressed plasma renin activity. The patient underwent successful laparoscopic removal of a renal oncocytoma.
We conclude that normotensive primary aldosteronism is not harmless; it can be associated with severe hypokalemia, anxiety, depression, hypertensive crisis and cardiovascular damage. Patients can also develop resistant hypertension. Adequate treatment can decisively improve the survival and quality of life of the patients with primary aldosteronism, but a correct diagnosis is needed first. Therefore, it must be considered as a diagnostic possibility in normotensive patients with unexplained hypokalemia or isolated hypertensive episodes.
Keywords:
- Normotension
- primary aldosteronism
- intraoperative hypertensive crisis
- anesthetic induction
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References
Rossi E, Perazzoli F, Negro A, Magnani A. Diagnostic rate of primary aldosteronism in Emilia-Romagna, Northern Italy, during 16 years (2000-2015). J Hypertens. 2017;35: 1691-1697.
Funder JW. Primary aldosteronism as a public health issue. Lancet Diabetes Endocrinol. 2016;4:972-973.
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6:41- 50.
Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889-1916.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: A retros-pective cohort study. Lancet Diabetes Endocrinol. 2018;6:51-59.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism. JAMA Cardiol. 2018;3:768-774.
Velema MS, de Nooijer AH, Burgers VWG, Hermus ARMM, Timmers HJLM, Lenders JWM, Husson O, Deinum J. Health-related quality of life and mental health in primary aldosteronism: A systematic review. Horm Metab Res. 2017;49:943-950.
Velema M, Dekkers T, Hermus A, Timmers H, Lenders J, Groenewoud H, Schultze Kool L, Langenhuijsen J, Prejbisz A, van der Wilt GJ, Deinum J. Spartacus investigators. Quality of life in primary aldosteronism: A comparative effective-ness study of adrenalectomy and medical treatment. J Clin Endocrinol Metab. 2018; 103:16-24.
Buffolo F, Monticone S, Tetti M, Mulatero P. Primary aldosteronism in the primary care setting. Curr Opin Endocrinol Diabetes Obes. 2018;25:155-159
Rossi GP. Does primary aldosteronism exist in normotensive and mildly hyper-tensive patients, and should we look for it? Hypertens Res. 2011;34:43- 46.
Karashima S, Kometani M, Tsujiguchi H, Asakura H, Nakano S, Usukura M, Mori S, Ohe M, Sawamura T, Okuda R, Hara A, Takamura T, Yamagishi M, Nakamura H, Takeda Y, Yoneda T. Prevalence of primary aldosteronism without hyper-tension in the general population: Results in Shika study. Clin Exp Hypertens. 2018; 40:118-125.
Stowasser M, Sharman J, Leano R, Gordon RD, Ward G, Cowley D, Marwick TH. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol Metab. 2005;90: 5070-5076.
Markou A, Pappa T, Kaltsas G, Gouli A, Mitsakis K, Tsounas P, Prevoli A, Tsiavos V, Papanastasiou L, Zografos G, Chrousos GP, Piaditis GP. Evidence of primary aldosteronism in a predominantly female cohort of normotensive individuals: a very high odds ratio for progression into arterial hypertension. J Clin Endocrinol Metab. 2013;98:1409-1416.
Moradi S, Shafiepour M, Amirbaigloo A. A woman with normotensive primary hyper-aldosteronism. Acta Med Iran. 2016;54: 156-158.
Ito Y, Takeda R, Takeda Y. Subclinical primary aldosteronism. Best Pract Res Clin Endocrinol Metab. 2012;26:485-495.
Kenny L, Rizzo V, Trevis J, Assimakopoulou E, Timon D. The unexpected diagnosis of phaeo-chromo-cytoma in the anaesthetic room. Ann Card Anaesth. 2018;21:307-310.
Song Y, Yang S, He W, Hu J, Cheng Q, Wang Y, Luo T, Ma L, Zhen Q, Zhang S, Mei M, Wang Z, Qing H, Bruemmer D, Peng B, Li Q. Chongqing primary aldosteronism study (CONPASS) group. Confirmatory Tests for the Diagnosis of Primary Aldosteronism: A Prospective Diagnostic Accuracy Study. Hypertension 2018;71:118-124.
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