Abstract
We report the case of a 41-year-old male patient with juvenile onset refractory hypertension while taking four drugs including a diuretic. Fourteen years before he underwent a complete investigation for secondary hypertension (including the aldosterone to renin ratio-ARR) that was negative. Since that, hypertension control gradually worsened, hypertensive organ damage aggravated and hypokalemia developed in spite of ACE inhibitor treatment. At the re-evaluation ARR was elevated, and the further workup for primary aldosteronism demonstrated an unilateral aldosterone producing adenoma that was surgically removed, with subsequent optimal blood pressure control with two anti-hypertensive drugs. In this case, the failure of the first screening prevented a correct diagnosis of primary aldosteronism, with consequent inadequate blood pressure control in following years and end organ damage. The case suggests the need of clinical follow-up and eventual reappraisal of patients showing a condition of refractory hypertension associated with hypokalemia despite a first negative screening test.
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References
Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889–1916.
Pizzolo F, Raffaelli R, Memmo A, Chiecchi L, Pavan C, Guarini P, et al. Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism. J Hypertens. 2010;28(1):135–42.
Stowasser M, Taylor PJ, Pimenta E, Ahmed AH, Gordon RD. Laboratory investigation of primary aldosteronism. Clin Biochem Rev. 2010;31:39–56.
Funder JW. Primary aldosteronism and low-renin hypertension: a continuum? Nephrol Dial Transplant. 2013;28:1625–7.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This study was not funded.
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All authors (Francesco Zorzi, Olivieri Oliviero, Paolo Brazzarola, Francesca Pizzolo) declare they have no conflict of interest.
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Informed consent was obtained from the patient included in the study.
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Zorzi, F., Olivieri, O., Brazzarola, P. et al. A Late Diagnosis of Primary Aldosteronism. High Blood Press Cardiovasc Prev 24, 347–349 (2017). https://doi.org/10.1007/s40292-017-0191-6
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DOI: https://doi.org/10.1007/s40292-017-0191-6