Abstract P103: A PATIENT'S 45 YEAR STORY AFTER 1 3/4 ADRENALECTOMY FOR PRIMARY ALDOSTERONISM DUE TO ADRENAL HYPERPLASIA: IMPROVED CONTOL WITH LO NA DASH DIET.

Abstract

This report relies on detailed hospital/clinic records from the UK provided by the patient(PK) and his physicians for review and synthesis. In 1976 an asymptomatic, 24 y/o college lad had a routine health screening BP of 245/125. He was admitted. HPI was negative for symptoms or prior history of HBP. FH was - for low K or HBP, + for CAD in men <50. PE: ? increased heart size, Fundi Grade II. Hypokalemic alkalosis was noted, a renal arteriogram was normal. Adrenal (Ad) CT showed a normal L Ad but the R was not visualized, plasma aldosterone (PALDO) was elevated but 24 hr urine ALDO was not. PRA was not available at this time. Ad venography was negative, but the R Ad could not be cannulated. The DX was bilateral disease. Spironolactone (S) was started at 300 mg/d. He was readmitted for surgery 2 months later. BP = 160/100 and K was normal. At surgery, L Ad was said to be 2x normal and it and 3/4 of the R Ad were excised. Oral cortisol coverage was needed for 2 months, then ACTH gel for 2 months. BP was lowered for about 2 months off medications but then returned to 200/110. S was restarted at 400 mg/d with good control but gynecomastia developed. BP control was attempted with S and hydralazine for several years but despite being normal at home was always high in the office. Age 33 noted to have K of 3.2 and muscle “fasciculations”. S was increased. AFIB developed at 51. He converted to NSR with Amiodarone. BP continued to be difficult to control till age 56 when he began to move to the DASH diet recommended by my (CEG) patient online support Group which I have managed now for 19+ years. At 58, he retired from teaching early to care for his wife. At 62, PALDO was 1300 and Renin was 10 on S+DASH diet (ENa 55, EK 139 mM/d). Then 600/1 off S + on high salt intake (ENa 125, EK 100 mM/d). At 60, MRI showed “adenoma R” Ad. Rx with S/enalapril continued with home BPs 122/84. At 65, non-ST MI diagnosed, PTA/stenting was performed. BP has been stable for last 3 years with home BP 120/80 on DASH Diet, Spiro 100/enalapril 20 mg/d. Statin myalgia prevented statins. Lipids and BP have improved on DASH. HBP returns when he deviates from DASH. This case shows that long-term survival after 1 3/4 adrenalectomy for Conn’s (due to hyperplasia) is possible and suggests moving to the DASH diet improves BP control (last 3 year AVE 112/73).