BACKGROUND: Primary aldosteronism is a common, treatable and potentially curable cause of hypertension. It is a much more common cause of hypertension than was previously thought, and aldosterone excess may have deleterious effects on the cardiovascular system that are at least partly independent of blood pressure elevation. Plasma aldosterone-renin ratio is currently the most reliable available screening test for primary aldosteronism.
OBJECTIVE: To determine the cases of primary aldosteronism using aldosterone-renin ratio as screening tool.
METHODOLOGY: This is a retrospective, descriptive study. Seventy-two charts of patients with plasma aldosterone and renin determination done were reviewed.
RESULTS: Forty-three patients had positive aldosterone-renin ratio (ARR?30). Only 23 submitted to a confirmatory test. Eighteen were females. The mean age was 40 y.o; the mean duration of onset of hypertension was 5 years prior to consult. Mean systolic and diastolic BP were 195mmHg and 100mmHg, respectively. All were hypokalemic. Fourteen showed a positive result in confirmatory saline infusion test. Computed tomography was done. Ten had unilateral adrenal nodule, 2 had adrenal limb thickening and 2 had bilateral adrenal lesions. Those with bilateral lesions underwent bilateral adrenal vein sampling, but no lateralization was demonstrated. They were given medical therapy, as well as the other 2 with adrenal limb thickening. The ten patients with unilateral adrenal lesions underwent unilateral adrenalectomy. Serum potassium normalized postoperatively; blood pressure improved but 3 patients continued to maintain on antihypertensive medication after surgery.
CONCLUSIONS: Primary aldosteronism is a potentially curable disease. Hypokalemia and blood pressure improve upon treatment. Case detection using plasma aldosterone-renin ratio be done in high risk group. Confirmatory test must be pursued in those with positive ratio. CT scan is helpful in detecting the lesion and adrenal vein sampling be done to lateralize the hyperfunctioning adrenal.

Human ; Male ; Female ; Adult ; Child Preschool ; Adrenalectomy ; Antihypertensive Agents ; Blood Pressure ; Cardiovascular System ; Hyperaldosteronism ; Hypertension ; Hypokalemia ; Potassium ; Renin ; Systole ; Renin-angiotensin System

BACKGROUND: Primary hyperparathyroidism is considered rare in pregnancy, and only about 200 cases have so far been reported in world literature. Severe adverse effects can occur to both the mother and fetus if left untreated. Parathyroidectomy remains the definitive treatment. We present a diagnosed case of primary hyperparathyroidism who underwent a minimally invasive parathyroidectomy with intraoperative PTH monitoring in the third trimester of pregnancy.                                                                                                                                                          CASE: A 38 year old female consulted our clinic due to a history of recurrent Urinary Tract Infection (UTI) and bilateral nephrolithiasis. Investigation revealed an ionized calcium level of 1.59mg/dl (normal value 1.05-1.25 mg/dl), and an intact PTH of 257 pg/ml. A parathyroid scintigraphy using Tc99m-sestamibi was done revealing a focal radioavid mass lesion immediately inferior to the left thyroid fossa, consistent with a parathyroid adenoma, approximately measuring 1.6cm x 1.1cm. She was advised surgical excision but opted to postpone surgery and medical therapy instead. After eight months, she followed up in our clinic, 30 weeks pregnant, with symptoms of nausea, vomiting and recurrent UTI. With recent ionized calcium of 1.6mg/dl, she agreed to the removal of the parathyroid tumor. Prior to her scheduled surgery, hydration was done and IV glucocorticoids were given to mature the lung surfactant of the fetus in case of premature labor induced by parathyroidectomy. At 34 weeks of gestation, patient underwent minimally invasive parathyroidectomy which revealed a parathyroid adenoma. Before the excision, intact PTH level was 877 pg/ml and 10 minutes after excision, the intact PTH dropped to 48.8 pg/ml. When the ionized calcium level dropped to 1.03 mg/dl post-operatively, the patient experienced mild transient abdominal contractions and with slight tingling sensation over the face. Calcium supplementation was given which normalized calcium levels. The patient subsequently had an uneventful postoperative recovery and had an uneventful antenatal course.
CONCLUSION: Surgeries for hyperparathyroidism in pregnant women are usually performed in the second trimester of pregnancy, on the other hand there is an ongoing debate regarding the safety performed during the third trimester of pregnancy. We presented a case that was successfully performed during the third trimester with minimally invasive parathyroidectomy. We also present this case due to its rare occurrence and discussed the preoperative management of pregnant patients with proper hyperparathyroidism.

Human ; Female ; Adult ; Glucocorticoids ; Hyperparathyroidism, Primary ; Mothers ; Nausea ; Nephrolithiasis ; Obstetric Labor, Premature ; Parathyroid Neoplasms ; Parathyroidectomy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Surface-active Agents ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Urinary Tract Infections ; Vomiting ; Hypercalcemia