HYPERTENSION AND HYPERALDOSTERONISM

Abstract

Objective: describe the importance of investigating secondary hypertension in cases of hypertension that is difficult to control through clinical signs Design and method: Case Report: Patient R.A., female, 47 years old, hypertensive for seventeen years appears in the emergency department with a report of a hypertensive peak in a periodic consultation. At the time she was asymptomatic with a blood pressure of 260 x 120 mmHg. The electrocardiogram showed sinus rhythm with reduced T wave amplitude, increased U wave amplitude, and increased QT interval. The laboratory test showed hypokalemia associated with metabolic alkalosis, and slight elevation of renal slag. Results: The investigation of arterial hypertension secondary to primary hyperaldosteronism was initiated with plasma aldosterone dosage and plasma renin activity, showing an AP/ARP ratio > 100 ng/mL/h. Computed tomography of the abdomen and pelvis showed adenoma in the right adrenal, which was resected laparoscopically. One month after hospital discharge, the patient returns to the emergency room with nausea, vomiting and general malaise. Laboratory with hyperkalemia and worsening of renal function. At this moment, the patient was using a potassium-sparing diuretic, considered as a possible cause of the disorder, since other tests performed did not show any alteration. The diuretic was discontinued, with clinical and laboratory evolutionary improvement. The patient is discharged from hospital, with adequate blood pressure control and stable renal function. Conclusions: Primary hyperaldosteronism is a clinical condition determined by excessive production of aldosterone, caused by bilateral adrenal hyperplasia or unilateral adenoma. Hyperaldosteronism is suspected when we observe hypertension associated with difficult control, hypokalemia, adrenal incidentaloma. The investigation continues through serum levels of aldosterone and renin activity, as well as imaging tests, such as computed tomography. Laparoscopic surgery is indicated, with a success rate between 30-60%. It is important to emphasize that regular follow-up after the surgical procedure is essential to control blood pressure, with the aim of preventing the progression of renal hypertensive disease.