PRIMARY ALDOSTERONISM AND PREGNANCY

Abstract

Objective: Primary aldosteronism (PA) may present in younger age and it may so complicate pregnancy if not diagnosed early. Our aim was to identify female patients in whom PA was diagnosed after pregnancy and to seek for possible complications during pregnancy. Design and method: Retrospective analysis of female patients with PA diagnosed and treated at our Department in the period from 2000 to 2017. Results: We found 12 patients with PA (age at diagnosis 32.4 ± 4.6 years, hypertension duration 5.4 ± 3.1 years) suffering from hypertension 2.4 ± 1.7 years before pregnancy (5 patients had hypertension diagnosed during pregnancy). Three subjects were pregnant twice before the final diagnosis of PA was made. In 8 cases, pregnancy was terminated with caesarean section (3 times due to preterm preeclampsia and twice due to significantly increased blood pressure) and in 7 cases by spontaneous delivery (twice due to term preeclampsia). Preterm delivery occurred in 5 cases – the earliest one in the sixth month of gestation (4 times due to blood pressure related complications). Subsequent diagnosis of PA [(sometimes with a long delay (12 years)] was made on the basis of significantly low potassium values (2.6 ± 0.4 mmol/l; 2 subjects suffered even from hypokalemic paralysis) and hypertension (mostly moderate), elevated plasma/serum aldosterone (57.4 ± 19.4 ng/dl) and suppressed plasma renin activity (0.33 ± 0.1 ng/ml/h) or plasma renin 3.25 ± 1 ng/l). Eleven subjects underwent laparoscopic adrenalectomy [in all cases, diagnosis of a larger cortical adenoma (16.5 ± 5.7 mm) was made] and one subject was classified with bilateral hyperplasia according adrenal venous sampling. Operation has normalized blood pressure in 8 subjects and has improved significantly blood pressure control in remaining 3 subjects. One patient became pregnant after adrenalectomy and her pregnancy went uneventful. Conclusions: Primary aldosteronism is associated with high rate of pregnancy-related complications. The most frequent one is preeclampsia, in some cases leading to preterm delivery. The best prevention of these complications is the early diagnosis of PA, in these particular hypertensive cases the awareness of hypokalemia.