Persistent severe hyperkalemia following surgical treatment of aldosterone-producing adenoma

  title={Persistent severe hyperkalemia following surgical treatment of aldosterone-producing adenoma},
  author={Cristina Preda and Laura Claudia Teodoriu and Sarolta Placinta and Alexandru Grigorovici and Stefana Catalina Bilha and Christina Ungureanu},
  journal={Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences},
  • C. Preda, L. Teodoriu, C. Ungureanu
  • Published 20 February 2020
  • Medicine, Biology
  • Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
Primary aldosteronism is one of the most common causes of secondary hypertension. This condition is characterized by autonomous hypersecretion of aldosterone which produces sodium retention and potassium excretion, resulting in high blood pressure and potential hypokalemia. Transient postoperative hyporeninemic hypoaldosteronism with an increased risk of hyperkalemia may occur in some patients. We report the case of a 63-year-old patient with persistent hypokalemia, periodic paralysis, and… 
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The prospective study shows the borderline persistent post-operative hypoaldosteronism in the presence of early renin recovery indicating incapability of the zona glomerulosa of the remaining adrenal gland to produce aldosterone.


A case of aldosterone-producing adenoma with severe postoperative hyperkalemia.
It is plausible that aldosterone synthesis of adjacent and contralateral adrenal glands is severely impaired in some cases with primary aldosteronism, as glucocorticoid synthesis in Cushing syndrome.
Clinical risk factors of postoperative hyperkalemia after adrenalectomy in patients with aldosterone-producing adenoma.
Older age, longer duration of hypertension, larger mass size on pathology, and impaired preoperative renal function were associated with prolonged postoperative hyperkalemia in patients with APA, and mineralocorticoid receptor (MR) antagonist use did not prevent postoperativehyperKalemia.
Prolonged zona glomerulosa insufficiency causing hyperkalemia in primary aldosteronism after adrenalectomy.
Persistent postoperative hypoaldosteronism with hyperkalemia occurs in 5% of adrenalectomized PA patients through prolonged ZG insufficiency, requiring long-term fludrocortisone treatment.
Severe hyperkalemia following adrenalectomy for aldosteronoma: prediction, pathogenesis and approach to clinical management- a case series
Post APA resection severe hyperkalemia may be a common entity and screening should be actively considered in high risk patients and at-risk patients should be counselled as to the meaning and importance of post-operative changes in measured renal function and potassium.
Insufficiency of the zona glomerulosa of the adrenal cortex and progressive kidney insufficiency following unilateral adrenalectomy – case report and discussion
Older patients and patients with long-lasting PA who are treated with UA may demonstrate deterioration of renal function and develop transient or persistent insufficiency of the zona glomerulosa of the remaining adrenal gland necessitating fludrocortisone supplementation.
Hyperkalemia in both surgically and medically treated patients with primary aldosteronism
The potential occurrence of hyperkalemia should be considered after medical as well as surgical treatment for PA, especially in patients with older age (>60 years) and impaired renal function.
Relative glomerular hyperfiltration in primary aldosteronism.
In 17 of the 25 PA patients who received a 6-mo treatment of spironolactone, both GFR and ERPF decreased in parallel with BP, similar to what was observed after surgery, suggesting that PA was associated with relative hyperfiltration, unmasked after suppression of aldosterone excess.
Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan
Age is the most important predictor of the progression of kidney dysfunction after adrenalectomy in Japanese patients with APAs, particularly those with a history of cardiovascular events and positivity for KCNJ5 mutations.
Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism.
Surgical treatment provided better hypertension and hypokalemia outcomes among patients with PA, compared to medical treatment, and MRAs may be appropriate for elderly patients with impaired renal function.