Endocrine Abstracts

Introduction: 30% of the adult population has high blood pressure. About 6% of the hypertension may be caused by primary aldosteronism and very rare by primary hyperparathyroidism. The combination of these two causes is very rare.

Case report: Our patient is women (age 50) with a 21 year long history of uncontrolled hypertension. Treatment of hypertension consist of a beta-blocker, calcium channel blockers, angiotensin converting enzyme inhibitor, loop diuretics and thiazide diuretics. Laboratory tests confirmed the presence of hypercalcemia (ionized calcium 1.42 mmol/l), and hypokalemia (3.4 mmol/l). After correction of medical therapy results shows elevated levels of parathyroid hormone (221.7 pg/ml) and aldosterone/renin ratio (A/R>30), normal value of metanephrines and normetanefrine, normal ACTH and cortisol levels and diurnal rithm of secretion. CT of the abdomen showed adenoma like enlargement of left adrenal gland of 2 cm. Scintigraphy and ultrasound confirmed the presence of hyperplasia/adenoma of the lower left parathyroid gland. Bone mineral density indicates osteoporosis and ultrasound of abdomen described nephrolithiasis in the left kidney. Due to hypercalcemia, first we have decided to operate the parathyroid glands. Surgery leads to normalization of calcium. The pressure is regulated without both the diuretics at a reduced dose of a calcium channel blockers. After recovering from surgery, in a hospital setting we discontinued therapy and dynamic testing was conducted (volume loading test and postural stimulation test) that indicate adrenal hyperplasia as a cause of primary hyperaldosteronism. Patient started with spironolactone therapy that even in small doses leads to normalization of potassium and reduce the need for other antihypertensive agents.

Conclusion: More endocrine disorders can simultaneously affect arterial hypertension. Treatment of hyperparathyroidism may lead to better control of hypertension. Despite the existence of left adrenal enlargement that looks like an adenoma, adrenal hyperplasia is a possible cause of primary hyperaldosteronism.