PS-R07-2: A DELAYED DIAGNOSED PRIMARY ALDOSTERONISM

Abstract

A 52-year-old man with a history of hypertension for more than ten years, hypokalemia (2.9 mmol/L lowest) and left adrenal nodule for four years was admitted to our department. Four years ago, he was hospitalized to screen for primary aldosteronism. Measurements of plasma aldosterone concentration (PAC) showed increases, while plasma renin activity (PRA) was in the normal range. Aldosterone-to-renin ratio (ARR) was less than 30 (pg/ml)/(ng/ml.h−1). The saline infusion test (SIT) was performed and showed the post-infusion PAC > 10 ng/dL while the suppression > 50%. Combined with the ARR, negative was considered and medical treatment was chosen. Four years later, his hypertension became resistant to control. He was admitted again. Before then, he was just diagnosed with obstructive sleep apnea syndrome and began using continuous positive airway pressure. However, the result of the ARR and SIT was similar to the previous, though the PRA was slightly lower. Primary aldosteronism was ultimately diagnosed this time. Adrenal venous sample was performed and showed lateralization was left. He received unilateral adrenalectomy. During the following, his blood pressure had significantly improved, and serum potassium and PAC returned to the normal range. In conclusion, in patients suspected of primary aldosteronism clinically, the concomitant condition should take into consideration.