Preda Cristina, Teodoriu Laura Claudia, Placinta Sarolta, Grigorovici Alexandru, Bilha Stefana, Ungureanu Christina M
Department of Endocrinology, University of Medicine and Pharmacy "Grigore T. Popa", Iaşi, Romania.
Department of Endocrinology, Emergency University Hospital "Sf. Spiridon," Iaşi, Romania.
J Res Med Sci. 2020 Feb 20;25:17. doi: 10.4103/jrms.JRMS_603_19. eCollection 2020.
Primary aldosteronism is one of the most common causes of secondary hypertension. This condition is characterized by autonomous hypersecretion of aldosterone which produces sodium retention and potassium excretion, resulting in high blood pressure and potential hypokalemia. Transient postoperative hyporeninemic hypoaldosteronism with an increased risk of hyperkalemia may occur in some patients. We report the case of a 63-year-old patient with persistent hypokalemia, periodic paralysis, and refractory hypertension who was diagnosed with primary hyperaldosteronism due to elevated aldosterone, undetectable plasmatic renin concentration, and the presence of a left adrenal mass. One month after the surgery, the patient was admitted with signs of severe hyperkalemia (8 mmol/L) and worsened renal function, thus requiring hemodialysis. Fluid resuscitation, loop diuretic, and sodium bicarbonate treatment decreased his potassium. Zona glomerulosa insufficiency was confirmed by hormonal tests which exposed low aldosterone-renin axis. The fludrocortisone treatment was initiated and maintained, with consequent potassium and creatinine stabilization. Old age, long duration of hypertension, impaired renal function, severe hypokalemia before surgery, and large size of the aldosterone-producing adenoma are important risk factors for serious potassium imbalance after removal of the adenoma. We have to consider monitoring the patients after surgery for primary hyperaldosteronism in order to prevent severe hyperkalemia; therefore, postoperative immediate follow-up (arterial pressure, potassium, and renal function) is mandatory.
原发性醛固酮增多症是继发性高血压最常见的病因之一。这种病症的特点是醛固酮自主分泌过多，导致钠潴留和钾排泄，从而引起高血压和潜在的低钾血症。一些患者术后可能会出现短暂性低肾素性醛固酮减少症，伴有高钾血症风险增加。我们报告了一例63岁患者，患有持续性低钾血症、周期性麻痹和难治性高血压，因醛固酮升高、血浆肾素浓度检测不到以及左肾上腺肿块而被诊断为原发性醛固酮增多症。手术后一个月，患者因严重高钾血症（8 mmol/L）和肾功能恶化入院，因此需要进行血液透析。液体复苏、袢利尿剂和碳酸氢钠治疗降低了他的血钾水平。激素检测证实了球状带功能不全，显示醛固酮 - 肾素轴降低。开始并维持氟氢可的松治疗，随后血钾和肌酐水平稳定。老年、高血压病程长、肾功能受损、术前严重低钾血症以及醛固酮分泌腺瘤体积大是腺瘤切除术后严重钾失衡的重要危险因素。我们必须考虑对原发性醛固酮增多症患者术后进行监测，以预防严重高钾血症；因此，术后立即进行随访（测量动脉压、血钾和肾功能）是必要的。
