Marques-Sá Juliana, Barbosa Mariana, Fernandes Vera, Santos Maria Joana
Endocrinology Department, Braga Hospital, Braga, Portugal.
Endocrinology Department, Braga Hospital, Braga, Portugal
BMJ Case Rep. 2021 Mar 22;14(3):e240018. doi: 10.1136/bcr-2020-240018.
A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.
一名既往健康的33岁产后女性在发生两次晕厥后被送往急诊科。在候诊室时，她突然晕倒，检测到心室颤动，通过电复律使其恢复心跳。入院时，她神志清醒，血压为102/74 mmHg，心率为78次/分。实验室检查发现严重低钾血症（血钾1.77 mEq/L）。腹盆腔CT显示右肾上腺有一个27 mm的结节。检测到醛固酮水平升高和血浆肾素水平降低，尽管她从未患过高血压，但仍诊断为原发性醛固酮增多症。随后，发现存在醛固酮和皮质醇共同分泌的情况。入院两个月后，患者在螺内酯治疗下血钾水平正常，病情稳定，并接受了右侧肾上腺切除术。原发性醛固酮增多症得到治愈，同时证实存在部分肾上腺功能不全。术后未进行治疗，血钾水平和血压仍保持正常，术后10个月停用氢化可的松。
