ECE2018 Poster Presentations: Adrenal and Neuroendocrine Tumours Adrenal cortex (to include Cushing's) (70 abstracts)
Intraoperative hypertensive crisis as a key symptom in a normotensive patient with primary aldosteronism – clinical case
Agnieszka Kuzior 1 , Ana Delia Santana-Suarez 1 , Manuel Esteban Nivelo-Rivadeneira 1 , Paula Fernandez-Trujillo-Comenge 1 , Claudia Arnas-Leon 2 , Carmen Acosta-Calero 2 , Sara Quintana-Arroyo 2 & Francisco Javier Martinez-Martin 2
1Endocrinology & Nutrition Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; 2Endocrinology & Nutrition Department, Hospitales San Roque, Las Palmas de Gran Canaria, Spain.
Primary aldosteronism is now recognized as the most frequent cause of secondary hypertension, accounting for 5–10% of the total cases of hypertension. Reportedly it is associated with a risk of cardiovascular events above and beyond hypertension development. Notwithstanding its high prevalence and serious complications, it is widely infradiagnosed. Hereby we present the case of a normotensive 50-year old female patient who was diagnosed of probable left hypernephroma, but after anesthetic induction surgery was aborted due to a hypertensive crisis. The patient was referred to our Endocrinology Clinic in order to rule out pheochromocytoma. Anamnesis revealed recurrent hypokalemia (up to 2.6 mEq/L). Glucose, glomerular filtration rate, lipids and TSH were normal, K+4.24 mEq/L, Aldosterone 59 ng/dL, PRA 0.7 ng/mL/h, ratio 84.3, Metanephrine 30 pg/mL, Normetanephrine 69 pg/mL, Cromogranine A 5.8 ng/mL. 24h ABPM showed normal mean values of BP and HR (118/76 mmHg, 77 bpm), with an isolated peak of 234/146 mmHg 81 bpm at 12:20. The abdominal CT report did not mention adrenal anomalies but on review the left adrenal image suggests nodular hyperplasia. A confirmatory captopril test did not elicit aldosterone suppresion (0’ – > 120’: 29.9 – > 21.7 ng/dL). The patient was treated with spironolactone 12.5 mg/day, she remains asymptomatic, with normokalemia, normotension and unsuppressed PRA. Pheochromocytoma was ruled out and a 4-cm left renal mass was successfully removed, the pathology diagnosis was oncocytoma, with negative extension. Surgical removal of the left adrenal was not considered. We conclude that normotensive primary aldosteronism is not harmless: it may cause hypertensive crisis and severe hypokaliemia. Evolution to resistant hypertension has also been reported. It must be considered as a diagnostic possibility in normotensive patients with unexplained hypokalemia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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