American Journal of Hypertension Research
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American Journal of Hypertension Research. 2013, 1(1), 13-16
DOI: 10.12691/ajhr-1-1-3
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Refractory Hypokalemia, Endocrine Hypertension, and the Role of Primary Hyperaldosteronism: A Case Report

Luljeta Çakërri1, Elira Myrtaj2, Florian Toti2 and Gentian Vyshka1,

1Biomedical and Experimental Department, Faculty of Medicine, University of Medicine in Tirana, Albania

2Service of Endocrinology, University Hospital Center “Mother Theresa”, Tirana, Albania

Pub. Date: October 22, 2013

Cite this paper:
Luljeta Çakërri, Elira Myrtaj, Florian Toti and Gentian Vyshka. Refractory Hypokalemia, Endocrine Hypertension, and the Role of Primary Hyperaldosteronism: A Case Report. American Journal of Hypertension Research. 2013; 1(1):13-16. doi: 10.12691/ajhr-1-1-3

Abstract

The case of an Albanian patient is reported, with bilateral adrenal hyperplasia diagnosed after a condition of persistent hypokalemia, in spite of continuous and adequate potassium administration. The patient, a Caucasian male of middle age, was suffering from diabetes, hypertension and angina pectoris, and admitted in a University Hospital Facility due to an unexplained confusional state. U waves were registered in the electrocardiography, and abdominal imaging was suggestive of adrenal hyperplasia. His plasmatic levels of potassium started to improve and became normal only after a therapy with potassium sparing diuretic, in our case with spironolactone. The administration of this type of drug has been widely advocated even for diagnostic purposes, when an unexplained condition of hypokalemia persists. Our case suggests that in lack of obvious causes of hypokalemia, suspicions on the existence of a primary hyperaldosteronism should be formulated, and investigations or therapeutic interventions have to be purposefully shaped.

Keywords:
primary hyperaldosteronism hypokalemia spironolactone adrenal gland hyperplasia

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References:

[1]  Conn JW. Primary aldosteronism. J Lab Clin Med. 1955 Apr; 45(4):661-4.
 
[2]  Conn JW. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med. 1955 Jan; 45(1):3-17.
 
[3]  Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians. 1955; 68:215-31; discussion, 231-3.
 
[4]  Brown NJ. This is not Dr. Conn's aldosterone anymore. Trans Am Clin Climatol Assoc. 2011; 122:229-43.
 
[5]  Foo R, O'Shaughnessy KM, Brown MJ. Hyperaldosteronism: recent concepts, diagnosis, and management. Postgrad Med J. 2001 Oct; 77(912):639-44.
 
[6]  Carter Y, Roy M, Sippel RS, Chen H. Persistent hypertension after adrenalectomy for an aldosterone-producing adenoma: weight as a critical prognostic factor for aldosterone's lasting effect on the cardiac and vascular systems. J Surg Res. 2012 Oct; 177(2):241-7.
 
[7]  Young WF Jr. Endocrine hypertension: then and now. Endocr Pract. 2010 Sep-Oct; 16(5):888-902.
 
[8]  Layden BT, Hahr AJ, Elaraj DM. Primary hyperaldosteronism: challenges in subtype classification. BMC Res Notes. 2012 Oct 30; 5:602.
 
[9]  Shigematsu K, Yamaguchi N, Nakagaki T, Sakai H. A case of unilateral adrenal hyperplasia being difficult to distinguish from aldosterone-producing adenoma. Exp Clin Endocrinol Diabetes. 2008; 117(3):124-128.
 
[10]  Viera AJ, Neutze DM. Diagnosis of secondary hypertension: an age-based approach. Am Fam Physician. 2010 Dec 15; 82(12):1471-8.
 
[11]  Sica DA. Endocrine causes of secondary hypertension. J Clin Hypertens (Greenwich). 2008 Jul; 10(7):534-40.
 
[12]  Akpunonu BE, Mulrow PJ, Hoffman EA. Secondary hypertension: evaluation and treatment. Dis Mon. 1996 Oct; 42(10):609-722.
 
[13]  Potthoff SA, Beuschlein F, Vonend O. [Primary hyperaldosteronism--diagnostic and treatment]. [Article in German] Dtsch Med Wochenschr. 2012 Nov; 137(48):2480-4.
 
[14]  North JD, Sims FH, Sayers EG. Primary aldosteronism. The value of spironolactone in diagnosis. Lancet. 1961 Sep 16; 2(7203):618-21.
 
[15]  Bear RA. A clinical approach to the diagnosis of acid-base disorders. Can Fam Physician. 1986 Apr; 32:823-7.
 
[16]  Devendra D, Rowe PA. Unexplained hypokalaemia and metabolic alkalosis. Postgrad Med J. 2001 Oct; 77(912):E4.
 
[17]  Mráz L, Rusavý Z, Zdenĕk P, Heidenreichová M, Kozeluhová J, Steinigerová J, Tĕsínský P. [A vasoactive-intestinal-polypeptide producing tumor (VIPoma) as an uncommon cause of life-threatening hypokalemia]. Vnitr Lek. 1995 Aug; 41(8):535-7.
 
[18]  Orme NM, Hart PA, Mauck KF. 46-year-old man with treatment-resistant hypertension. Mayo Clin Proc. 2010 Oct; 85(10):e70-3.
 
[19]  Delyani JA. Mineralocorticoid receptor antagonists: the evolution of utility and pharmacology. Kidney Int. 2000 Apr; 57(4):1408-11.
 
[20]  Spence JD. Physiologic tailoring of treatment in resistant hypertension. Curr Cardiol Rev. 2010 May; 6(2):119-23.
 
[21]  Jeunemaitre X, Chatellier G, Kreft-Jais C, Charru A, DeVries C, Plouin PF, Corvol P, Menard J. Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol. 1987 Oct 1; 60(10):820-5.
 
[22]  Rastegar A, Soleimani M. Hypokalaemia and hyperkalaemia. Postgrad Med J. 2001 Dec; 77 (914):759-64.
 
[23]  Kokot F, Hyla-Klekot L. Drug-induced abnormalities of potassium metabolism. Pol Arch Med Wewn. 2008 Jul-Aug; 118(7-8):431-4.