Endocrine Abstracts

The four major hypertensive disorders in pregnancy are preeclampsia/eclampsia/HELLP syndrome, gestational hypertension, chronic hypertension and pre-eclampsia superimposed on chronic hypertension. The prevalence of hypertension in pregnancy has been reported to be around 6%. The commonest aetiology was found to be gestational hypertension which made up 40% of all cases. To our knowledge, secondary causes of hypertension in pregnancy has never been well described. We present a 20 year old gravid patient who initially presented with an incidentally raised blood pressure of 147/79mmHg at 13 weeks of gestation. She had a previous miscarriage the year before at 16 weeks and her blood pressure readings during said gestation had been normal. She was coincidentally found to have hypokalemia with a reading of 2.3 mmol/l and metabolic alkalosis with a pH of 7.514 and a bicarbonate level of 34.1 mmol/l. She was admitted to the ward and required multiple IV potassium replacements and high dose oral potassium supplements before her potassium levels reached a stable level. During her admission her blood pressure remained elevated and had been difficult to control, with the highest reading at 164/116mmHg. She was started on oral methyldopa and required multiple dose titrations. Her plasma aldosterone level was found elevated at 4030pmol/l and her renin level was at the low end of normal with a reading of 1.4nmol/l. Radiological investigation revealed an 8mm adenoma at her left adrenal. A provisional diagnosis of hyperaldosteronism was made and she was subsequently started on Eprenolone and her methyldopa was switched to labetalol. Her hypokalemia and hypertension thereafter remained well controlled. As she was currently in her second trimester of her pregnancy, it was elected that further interventions were to be carried out post partum. This case highlights the rare occurrence of primary hyperaldoseteronism in pregnancy and the complexity in managing such cases.