Primary aldosteronism - A cause of hypertension

Abstract

Context: The vast majority of patients with hypertension present the primary form. However, secondary forms may arise in the course of the disease, the most prevalent being the primary hyperaldosteronism. Between the two main causes are the aldosterone- producing adenoma and adrenal hyperplasia, the first being most common. Case description: 74 years old male patient, hypertensive with chronic atrial fibrillation controlled with diuretics and anti-arrhythmic drug, subjected to valvuloplasty for mitral stenosis, is in the query by elevated blood pressure levels associated with syncope and palpitations. In laboratory evaluation was detected hypokalemia, which raised the suspicion of adverse effect of diuretic and / or hyperaldosteronism. The final diagnosis was confirmed after further studies, which indicated high plasmatic and urinary aldosterone and low plasmatic renin. The computed tomography detected a solid nodule in right adrenal, consistent with adenoma. The patient was referred for consultation of Endocrinology, medicated with spironolactone.Awaiting possible unilateral adrenalectomy. Comment: The case shows that during the development of hypertension, secondary potentially curable cases may occur, for which the family doctor must be alert.A detailed medical history and a thorough physical examination, associated with the application of the diagnostic tests, make it possible to ascertain the cause of secondary hypertension. This case is illustrative of the importance that is the continuity of care provided by family doctors and of a good coordination between primary care and hospital care.