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Abstract: A 47-year-old female patient with 15 days of dizziness was found to have a blood pressure of up to 171/120 mmHg, low potassium, elevated aldosterone levels, low renin activity, and a CT scan of the adrenal glands suggesting a small left adrenal nodular shadow. Initially, secondary hypertension was suspected, and further saline suppression test was performed to confirm secondary hypertension caused by primary aldosteronism. After surgery, the left adrenal gland was removed. After surgery, the blood pressure improved, the blood potassium returned to normal, and the aldosterone and renin metabolism disorder was corrected.
Basic information】Female, 47 years old
Disease Type】Primary aldosteronism
Hospital】Zhejiang Provincial People’s Hospital
Date of consultation】August 2020
Treatment plan】Surgical treatment (left adrenalectomy) + medication (levoclodipine maleate tablets)
Treatment period】3 days of inpatient treatment, 1 month of outpatient follow-up review
Treatment effect】Reduced antihypertensive drugs by half, clinical symptoms and biochemical indexes improved significantly
I. Initial consultation
The patient is a 47-year-old female who has been taking regular medication (levoclodipine maleate tablets) for a long time to treat her hypertension, but her blood pressure is under control but fluctuates greatly. She had an annual physical examination, routine blood tests, blood biochemistry, electrocardiogram, abdominal ultrasound, chest X-ray, etc. Occasionally, her blood potassium was mildly low, but other abnormalities were not apparent. No screening for secondary factors of hypertension has been performed since the consultation, and it is not clear whether the hypertension is primary or secondary. It is recommended that the blood potassium be rechecked and further tests for thyroxine, aldosterone, renin, and adrenal ultrasound and CT be performed.
II. Treatment history
The patient’s calculated body mass index was 23.88, blood potassium 3.44 mmol/L, blood sodium 141.4 mmol/L, urine pH 7.0, blood aldosterone 246.1 pmol/L, and renin activity 0.302 ng/mL/h. Adrenal ultrasound showed no significant abnormalities. In combination with the above treatment, a score using the PSS scale, a screening tool for primary aldosteronism, was performed, with age 3, blood potassium 4, blood sodium 2, and BMI of 1, for a total score of 10, with a high suspicion of primary aldosteronism. A further CT scan of the adrenal gland revealed a possible small nodule and adenoma in the patient’s left adrenal gland. The left adrenalectomy was then performed with the patient’s consent.
III. Treatment effect
Three days after surgery, the patient’s blood pressure dropped significantly, aldosterone level decreased, blood potassium and renin activity increased, and the dosage of levoclodipine maleate tablets decreased. mL/h, and blood pressure fluctuations were also significantly better than before.
IV. Notes
We are glad that the patient’s condition is under control, but we still need to advise the patient to pay attention to low-salt diet, appropriate participation in exercise, regular work and rest, and avoid prolonged stress or tension and anxiety. You can continue to take small doses of levoclodipine maleate tablets to control blood pressure. If blood pressure decreases further or if you experience a seasonal drop in blood pressure, you can also follow medical advice to further reduce the dosage or stop the drug for observation. During the annual physical examination, review the adrenal ultrasound, aldosterone, renin, cortisol and potassium levels on top of the routine examination to see if there are any changes in the currently normal right adrenal gland.
V. Personal insight
Blood aldosterone primary aldosteronism is one of the more common secondary factors of hypertension, and this patient was more fortunate to simply have secondary elevated blood pressure, which fortunately did not cause adverse effects such as cardiac hypertrophy and renal insufficiency. In this patient, surgical treatment was able to actually lower aldosterone levels, restore inhibited renin activity, stabilize blood pressure levels, and improve long-term prognosis compared with antihypertensive medication alone.