Intraoperative hypertensive crisis in a patient with normotensive primary aldosteronism. Lessons from a clinical case 1 MedDocs Publishers Received: Aug 22, 2018 Accepted: Jan 25, 2019 Published Online: Jan 30, 2019 Journal: Journal of Nephrology and Hypertension Publisher: MedDocs Publishers LLC Online edion: hp://meddocsonline.org/ Copyright: © Marnez-Marn FJ (2019). This Arcle is distributed under the terms of Creave Commons Aribuon 4.0 Internaonal License *Corresponding Author(s): Francisco Javier Marnez-Marn Hypertension Outpaent Clinic, University Hospital of Gran Canaria Doctor Negrin, Barranco de la Bal- lena S/N, 35011 Las Palmas de Gran Canaria, Spain Email: [email protected] Cite this arcle: Marnez-Marn FJ, Kuzior A, Nivelo-Rivadeneira ME, Fernandez-Trujillo PC, Perdomo-Herrera E, et al. Intraoperave hypertensive crisis in a paent with normotensive primary aldosteronism. Lessons from a clinical case. J Nephrol Hypertens. 2019; 2(1): 1008. Keywords: Normotension; Primary aldosteronism; Intraopera- ve hypertensive crisis, Anesthec inducon. Abstract Primary hyperaldosteronism is the most frequent cause of secondary hypertension. However, it can also be found in apparently normotensive paents, oſten associated with recurrent hypokalemia and isolated hypertensive episodes. We hereby present the case of a normotensive 50 year- old female paent with a surgical leſt kidney mass; however, aſter anesthec inducon, surgery was aborted due to a se- vere hypertensive crisis. She was referred to our Hyperten- sion Outpaent Clinic to rule out pheochromocytoma/para- ganglioma. The anamnesis revealed unexplained episodes of hypokalemia. Ambulatory blood pressure monitoring showed normal mean values of blood pressure and heart rate, with an isolated hypertensive peak. Plasma glucose, ions, creanine, lipids, metanephrines and chromogranin A were normal, but plasma aldosterone was clearly elevated with suppressed plasma renin acvity and high aldoster- one/renin acvity rao. Primary aldosteronism was con- firmed by the captopril test. Abdominal CT was compable with leſt adrenal hyperplasia. Treatment with low-dose spironolactone was well tolerated and resulted in normal blood pressure, normokalemia and unsuppressed plasma renin acvity. The paent underwent a successful laparo- scopic removal of a renal oncocytoma. Journal of Nephrology and Hypertension Open Access | Case Report Agnieszka Kuzior 1 ; Manuel Esteban Nivelo-Rivadeneira 1 ; Paula Fernandez-Trujillo-Comenge 1 ; Esperanza Perdomo-Herrera 2 ; Alba Lucia Tocino-Hernandez 3 ; Marta Marn-Perez 4 ; Paula Gonzalez-Diaz 3 ; Maria Victoria Sainz de Aja-Curbelo 5 ; Ana Delia Santana-Suarez 1 ; Francisco Javier Marnez-Marn 6 * 1 Endocrinology and Nutrion Department, University Hospital of Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain 2 Escaleritas Primary Healthcare Center, Las Palmas de Gran Canaria, Spain 3 Arucas Primary Healthcare Center, Las Palmas de Gran Canaria, Spain 4 Guia Primary Healthcare Center, Las Palmas de Gran Canaria, Spain 5 Barrio Atlanco Primary Healthcare Center, Las Palmas de Gran Canaria, Spain 6 Hypertension Outpaent Clinic, University Hospital of Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain Abbreviaons: ABPM: Ambulatory Blood Pressure Monitoring; BP: Blood Pressure; CT: Computed Tomography; HR: Heart Rate; MRA: Mineralocorcoid Receptor Antagonists; PA: Primary Al- dosteronism; PRA: Plasma Renin Acvity. ISSN: 2637-9619
Intraoperative hypertensive crisis in a patient with normotensive primary aldosteronism. Lessons from a clinical case
Apr 21, 2023
Primary hyperaldosteronism is the most frequent cause
of secondary hypertension. However, it can also be found
in apparently normotensive patients, often associated with
recurrent hypokalemia and isolated hypertensive episodes.
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We hereby present the case of a normotensive 50 yearold female patient with a surgical left kidney mass; however, after anesthetic induction, surgery was aborted due to a severe hypertensive crisis. She was referred to our Hypertension Outpatient Clinic to rule out pheochromocytoma/paraganglioma. The anamnesis revealed unexplained episodes of hypokalemia.
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