Primary aldosteronism – a multidisciplinary approach

Introduction: Primary aldosteronism is an important pathology not only because of its prevalence, but also because patients with this disease have higher cardiovascular morbidity and mortality than age-and sexmatched patients with essential hypertension and the same degree of blood pressure elevation. Methods: We present the case of a 63 year old hypertensive patient, with insulin treated type 2 diabetes mellitus complicated with nephropathy and diabetic polyneuropathy, who addressed the clinic for evaluation in the context of impaired general condition. Clinical and laboratory picture marked by muscle pain, fatigue, occipital headache and hypokalemia raised the suspicion of primary aldosteronism. The abdominal computer tomography revealed a cystic lesion of the right adrenal gland. The patient was referred to the endocrinology clinic for further investigation and the standardised determination of the aldosterone/renin ratio was in favour of our diagnostic hypothesis. Results: Unilateral laparoscopic adrenalectomy was per formed and the pathological examination confirmed the diagnosis of right adrenal adenoma. The subsequent evolution of the patient was favorable with good control of blood pressure values. Conclusions: Primary aldosteronism may be present in patients who associate multiple cardiovascular risk factors delaying the diagnosis and optimal therapy requiring a high degree of suspicion in patients with elevated blood pressure and hypokalemia.

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