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Sun J, Zeng Q, Lai L, Gu M, Liu D, Wu G, Peng C, Yang S, Li Q, Lu J. Severe hydronephrosis complicated with primary aldosteronism: a case report and review of the literature. J Med Case Rep 2024; 18:463. [PMID: 39369228 PMCID: PMC11456234 DOI: 10.1186/s13256-024-04798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/04/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Primary aldosteronism is characterized by high plasma aldosterone and low renin. The plasma aldosterone-to-renin ratio is recommended for screening. Severe hydronephrosis leads to renal parenchymal ischemia, resulting in increased renin secretion. Since nonsuppression of renin may cause a negative result in the aldosterone-to-renin ratio test, severe hydronephrosis and primary aldosteronism occurring simultaneously in a patient are challenging to diagnose. CASE PRESENTATION A 54-year-old Chinese man of Han ethnicity was diagnosed with hypertension and severe hypokalemia (minimum 1.57 mmol/L) 13 years prior, and was also diagnosed with severe hydronephrosis due to congenital ureteral stenosis on the left side. His clinical features suggested primary aldosteronism, but the aldosterone-to-renin ratio result of the patient was negative every time he underwent the primary aldosteronism screening test. No further treatment for primary aldosteronism was performed, which led the patient to suffer from severe hypokalemia, such that he was taking 12-15 g/day potassium chloride orally to keep his blood potassium between 3.0 and 3.5 mmol/L (reference value, 3.5-5.5 mmol/L) for 13 years, and the patient needed to be hospitalized in the intensive care unit for rescue several times. At admission, although the aldosterone-to-renin ratio result of the patient was negative, we still did the saline stress test and captopril inhibition test, and the results showed that the plasma aldosterone level was not lower after the test than before the test. Adrenal enhanced computed tomography suggested an adenoma in the left adrenal gland, and the results of adrenal vein sampling suggested that the left side was the dominant side. Therefore, laparoscopic total resection of the left adrenal gland was performed, and 2 weeks later, the patient developed short-term renal function impairment and hyperkalemia, but his renal function and blood potassium returned to normal after treatment that included fluid rehydration. The patient's biochemical test results and clinical symptoms were completely normal after 1 year. CONCLUSION We suggest that for patients with a high suspicion of primary aldosteronism in the clinic, comprehensive analysis must be performed in combination with clinical characteristic assessments, such as severe hydronephrosis, if renin is within the normal range or if the aldosterone-to-renin ratio result is negative at screening and diagnostic tests, and adrenal vein sampling should be performed if necessary. It can help avoid misdiagnoses and contribute to the treatment of patients with severe hydronephrosis and primary aldosteronism.
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Affiliation(s)
- Jianjuan Sun
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China
| | - Qiurong Zeng
- Department of General Practice, Chongqing University Fuling Hospital, Fuling, China
| | - Longbing Lai
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China
| | - Mingjun Gu
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China
| | - Dingrong Liu
- Department of Pathology, Chongqing University Fuling Hospital, Fuling, China
| | - Guangxiu Wu
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China
| | - Chuan Peng
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China
| | - Shuming Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangang Lu
- Department of Endocrinology and Metabolism, Chongqing University Fuling Hospital, No. 2 Gaosuntang Road, Fuling, China.
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Queiroz NL, Stumpf MAM, Souza VCM, Maciel AAW, Fagundes GFC, Okubo J, Srougi V, Tanno FY, Chambo JL, Pereira MAA, Pio-Abreu A, Bortolotto LA, Latronico AC, Barisson Villares Fragoso MC, Drager LF, Mendonça BB, Almeida MQ. Renal Function Evolution and Hypoaldosteronism Risk After Unilateral Adrenalectomy for Primary Aldosteronism. Horm Metab Res 2024; 56:350-357. [PMID: 38040032 DOI: 10.1055/a-2221-3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Few studies demonstrated a percentage decrease in the estimated glomerular filtration rate (eGFR) at a single time and the rate of hypoaldosteronism after adrenalectomy for primary aldosteronism (PA). Our aim was to investigate the evolution of renal function and the hypoaldosteronism risk after adrenalectomy for PA. Aldosterone, renin, eGFR, and electrolyte levels were determined before and at 1 week, 1, 3 and 6 months after unilateral adrenalectomy in 94 PA patients (40 men and 54 women). The main outcome was the postoperative eGFR decline using analysis of covariance with the preoperative eGFR as a covariate. eGFR decreased during first postoperative week compared to 3 months before surgery. During the first 6 months, eGFR remained stable at similar levels to the first week after surgery. Age (p=0.001), aldosterone levels (p=0.021) and eGFR 3 months before surgery (p+<+0.0001) had a significant correlation with eGFR during first postoperative week. High aldosterone levels at diagnosis were correlated with decline in renal function in the univariate model (p=0.033). In the multivariate analysis, aldosterone levels at diagnosis had a tendency to be an independent predictor of renal function after surgery (p=0.059). Postoperative biochemical hypoaldosteronism was diagnosed in 48% of the cases after adrenalectomy, but prolonged hyperkalemia occurred in only 4 cases (4.5%). Our findings showed a decrease of eGFR after unilateral adrenalectomy for PA. Additionally, aldosterone levels at diagnosis correlated with postoperative renal function. Postoperative biochemical hypoaldosteronism occurred in almost half of the patients, but prolonged hyperkalemia with fludrocortisone replacement was less frequent.
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Affiliation(s)
- Nara L Queiroz
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Matheo A M Stumpf
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Victor C M Souza
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Ana Alice W Maciel
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Gustavo F C Fagundes
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Jessica Okubo
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Victor Srougi
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Fabio Y Tanno
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Jose L Chambo
- Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Maria Adelaide A Pereira
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Andrea Pio-Abreu
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Ana Claudia Latronico
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Adrenal & Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Berenice B Mendonça
- Unidade de Adrenal & Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Madson Q Almeida
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo Faculdade de Medicina, Sao Paulo, Brazil
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