A patient with concurrent primary aldosteronism and Page kidney

Abstract

The ratio of aldosterone-to-renin activity is currently recommended as a screening test for primary aldosteronism (PA). There are many factors interfering the interpretation of aldosterone-renin ratio (ARR) and could hamper in-time diagnosis of PA. Here, we first report a patient with underlying Page phenomenon and an accidentally disclosed adrenal incidentaloma. High renin secretion from Page phenomenon had masked higher ARR into normal ARR obscuring the diagnosis of PA. However, adrenal venous sampling (AVS) confirmed the autonomous aldosterone secretion with left adrenal vein plasma aldosterone concentration (PAC) 124.1 ng/dl and a lateralization ratio 3.3. AVS may discriminate masked PA due to high renin secretion from Page kidney. It is suggested that clinicians should cautiously interpret aldosterone-renin ratio and consider diagnostic AVS if hyperaldosteronism is highly suspected especially in the background of other secondary hypertension.

<p>Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care</p>

“…Only 12.1% of the patients required amputation in association with osteomyelitis. The multidisciplinary approach is a key factor in decreasing reulceration and thus reducing the amputation rates, as previous studies have demonstrated 14,15. In 61.8% of the cases, the healing time was longer than 1 year.…”

Contrast‐enhanced MRI index of diffuse myocardial fibrosis is increased in primary aldosteronism

“…Twenty‐five patients with biochemically confirmed PA and 12 age‐matched healthy volunteers were recruited. The diagnosis of PA in hypertensive patients was made based on the confirmatory protocol provided by the TAIPAI (Taiwan Primary Aldosteronism Investigators) study group (19), which required the following diagnostic criteria: evidence of autonomous excess of aldosterone production presented as plasma aldosterone‐to‐renin activity (ARR) >35 (ng/dL per ng/mL/hr) and plasma aldosterone concentration (PAC) >10 ng/dl after either captopril or saline infusion tests. Patients with known renal dysfunction or serum creatinine over 1.8 mg/dL were excluded from this study.…”

Primary Aldosteronism Masked by Accessory Renal Arteries: A Case Report

“…However, the diagnostic algorithm can be challenging due to several factors that are known to affect the secretion of renin and aldosterone, such as medications, serum potassium, and so on [ 8 , 9 , 10 ]. In addition, the existence of other causes of secondary hypertension can also interfere with the interpretation of ARR and thus hamper the diagnosis of PA [ 11 , 12 , 13 ]. Here, we report the first case of a patient with bilateral accessory renal arteries and an aldosterone-producing adenoma.…”