Endocrine Abstracts

Introduction: Primary aldosteronism (PA) is widely recognized as the most common form of secondary hypertension (1). PA, also known as Conn syndrome, is a group of pathological conditions associated with an aldosterone secretion inappropriate for sodium intake, that is relatively autonomous from renin–angiotensin system activity and potassium levels.

Clinical Case 1: Thirty two year-old patient, diagnosed since 11 months with arterial hypertension with peaks reaching 18 of systolic. The patient reported intermittent headaches and a recent weight gain of 7 kg. Clinically, we noted blood pressure at 15/8 cmhg, acanthosis nigricans and Buffalo hump. Biological tests revealed: normal kidney function, urinary methoxylate derivatives and urinary free cortisol were negative, Aldosterone:1318 pmol/l, Rénine: 6,3 mUI/l, Aldosterone to Rénine Ratio (ARR) very high at 209. Abdominal CT scan showed nodular left adrenal formation, well-limited rounding, <10 of spontaneous density measuring 22*18 mm. The patient underwent left adrenalectomy, anatomopathological study was in favor of an adrenocortical adenoma. Evolution was marked by the normalization of blood pressure.

Clinical Case 2: Fifty six year-old patient, diagnosed since 1 year with arterial hypertension, wich despite triple antihypertensive therapy, remained poorly controlled. The patient reported fatigability with muscle cramps. Clinically, we noted high BP at 16/9 cmhg. Biological tests revealed: kidney faillure with 13 ml/mn of creatinine clearance, chronic hypokalemia, Aldosterone to Rénine Ratio (ARR) was superior than 70. Abdominal CT scan showed nodular left adrenal formation, measuring 25 mm. The patient underwent left adrenalectomy, anatomopathological study was in favor of an adrenocortical adenoma.

Discussion: Prevalence of PA varies from 6 to 18 %. While the majority of cases of PA are sporadic, four forms of autosomal-dominant inheritance have been described: familial hyperaldosteronism types I to IV. Severe or resistant hypertension, association with hypokalemia represent conditions which requires screening for PA. The Aldosterone -to-Renine Ratio has higher sensitivity than other measures. Antihypertensive drugs that can be maintained during exploration include alpha-blockers and calcium channel blockers ideally long-acting and non-dihydropyridine antagonists (2). Treatment of PA amis at preventing or correcting hypertension, hypokalemia and target organ damage. Spironolactone controls hypertension and hypokalemia and may prevent postoperatve hypoaldosteronism. Partial adrenalectomy and non-surgical ablation have no proven avantage over total adrenalectomy.

Conclusion: PA is one of the most frequent causes of secondary hypertension. Prevention requires screening for hypertensive patients, to enable specific medical or surgical management to avoid cardiovascular morbidity and mortality.

Keywords: primary aldosteronism, ARR, adenoma.