Endocrine Abstracts

Primary hyperaldosteronism may be due to an adrenal adenoma and is an increasingly recognized cause of secondary arterial hypertension. The disease causes hypokalemia and is usually treated surgically by excision of the adrenal adenoma. However, it appears that it may present with a clinical profile without arterial hypertension. The aim was to describe three cases of primary hyperaldosteronism who presented with hypokalemia and an adrenal adenoma with normal blood pressure. A cohort of three patients is described who presented with hypokalemia in all cases and mild diabetes mellitus in one case. All patients were female, aged 51, 54 and 72 years at the time of diagnosis. Diagnostic evaluation revealed the presence of a small adenoma in the left adrenal gland in two cases and in the right adrenal in one case. Aldosterone levels were elevated while renin was suppressed. In all patients blood pressure levels were normal. Spironolactone was administered in small doses for the management of hypokalemia. During follow up all patients continued to have hypokalemia, however blood pressure levels remained within the normal range. Primary hyperaldosteronism may present with severe arterial hypertension, persisting even after surgical excision of the adrenal adenoma which causes the disease. In many cases surgical treatment is considered successful if drug treatment for hypertension is reduced post surgically. Additionally, the disease may cause significant damage in the target organs affected by hypertension, namely, the heart and kidneys. It appears that although primary hyperaldosteronism is a cause of secondary arterial hypertension, the disease may present with a clinical phenotype without hypertension. This poses new therapeutic alternatives to the clinician. The disease may be managed by follow up, surgical excision of the adenoma being an option, if the clinical profile of the disease changes and creates new problems for the patient.