Davis Konnor, Gilani Christopher J, Sudario Gabriel
University of California, Irvine, School of Medicine, Irvine, California.
University of California, Irvine, Department of Emergency Medicine, Orange, California.
Clin Pract Cases Emerg Med. 2022 Aug;6(3):208-211. doi: 10.5811/cpcem2022.6.56522.
Patients with history of abdominal aortic aneurysm (AAA) undergoing surgical repair can have a myriad of surgical complications including compromise to large arteries branching from the aorta. Secondary hyperaldosteronism, characterized by high levels of aldosterone and renin, can be due to a multitude of causes, including renal artery stenosis, and presents with nonspecific symptoms of fatigue, increased thirst, and muscle spasms. While it can initially be difficult to diagnose given its multitude of metabolic abnormalities, secondary hyperaldosteronism is important to consider in patients presenting with uncontrolled hypertension, hypokalemia, and metabolic alkalosis.
This report explores the case of a 65-year-old male with a complicated medical history presenting to the emergency department with hypokalemia and hypertension six months after undergoing endovascular repair for an AAA and was found to have metabolic abnormalities including hypokalemia and metabolic alkalosis consistent with secondary hyperaldosteronism, likely secondary to renal artery stent stenosis. He was admitted to the hospital for four days and made a full recovery.
This case highlights the need to understand, identify, and accurately diagnose hyperaldosteronism and recognize post-AAA repair complications of renal artery stenosis as a cause of this metabolic derangement.
接受手术修复的腹主动脉瘤（AAA）患者可能会出现多种手术并发症，包括发自主动脉的大动脉受损。继发性醛固酮增多症的特征是醛固酮和肾素水平升高，可由多种原因引起，包括肾动脉狭窄，其表现为疲劳、口渴增加和肌肉痉挛等非特异性症状。虽然鉴于其多种代谢异常，最初可能难以诊断，但继发性醛固酮增多症在出现血压控制不佳、低钾血症和代谢性碱中毒的患者中是需要考虑的重要因素。
本报告探讨了一名65岁男性的病例，该患者有复杂的病史，在接受AAA血管内修复术后六个月因低钾血症和高血压就诊于急诊科，发现有代谢异常，包括与继发性醛固酮增多症一致的低钾血症和代谢性碱中毒，可能继发于肾动脉支架狭窄。他住院四天后完全康复。
本病例强调了理解、识别和准确诊断醛固酮增多症以及认识到AAA修复术后肾动脉狭窄并发症是这种代谢紊乱原因的必要性。
