Endocrine Abstracts

PH during pregnancy is a rare entity with no standardized practice management guidelines available. We report a case of a Latin American 40-year-old patient, with a history of arterial hypertension first diagnosed during her first gestation followed in Ecuador. She presented at 24 weeks’ gestation with a fetal demise and high blood pressure, being diagnosed of severe preeclampsia. Cesarean section (CS) was performed. No further control of blood pressure after delivery was reported. Three years after she was referred to our unit at 10 weeks’ gestation because of severe hypertension. She was treated with labetalol 600 mg and nifedipine 60mg reporting an optimal arterial blood pressure control until 38 weeks’ when a CS was performed. The newborn was a male weighing 2850 g with good perinatal outcome. During her postpartum hospitalization hypertensive peaks and a hypokalemia was observed and treated with valsartan 320 mg and amlodipine 10 mg. PH was diagnosed with a confirmatory test of renin-aldosterone stimulation with furosemide-standing. An adrenal computed tomography (CT), demonstrated a left adrenal node, 20 mm in diameter. Catheterization was not required and treatment with spironolactone 100 mg/daily was started with an optimal control. Adrenalectomy was recommended but it was postponed since she became pregnant again. We visited her at 6 weeks’ gestation. We decided to continue treatment with spironolactone at high doses (100 mg/daily) with the consent of the patient until week 20 and reduced the dose to 50 mg/daily due to the possible reported side effect of decrease placental flow. Labetalol 400mg/daily was added to keep blood pressure under optimal control. A CS was performed at 40 weeks’ gestation. A female newborn was obtained, weight 3160 g, Apgar 9/10. At follow up, an uncomplicated laparoscopic adrenalectomy was performed, and no further antihypertensive treatment was needed.

Conclusion: Despite the few cases described in the literature, in our experience the treatment with spironolactone at high doses during the first half of gestation allowed a correct management of the blood pressure and probably had a role in preventing preeclampsia with no malformations or adverse effects perinatal. In our case, we didn’t choose eplerenone, since the patient was already on spironolactone at time of consultation, was a female fetus and the lack of literature on eplerenone prenatal safety. However eplerone may be recommended in planned gestations to avoid the possible feminizing effect of spironolactone scarcely reported.