Normotensive presentation in primary aldosteronism: A report of two cases

Abstract

Normotensive patients with primary aldosteronism (PA) are relatively rare. Herein, we report two patients with normotensive PA and present a literature review to improve an understanding of the disease. Patient 1, a 56-year-old man, presented with recurrent hypokalemia that lasted for more than 2 years. Patient 2 was a 33-year-old man who presented with sexual dysfunction and was diagnosed with a prolactinoma combined with adrenal insufficiency and hypogonadism. Neither of these patients had hypertension that was detectable on repeated manual measurements. In both patients, a typical biological profile of PA was demonstrated that included hypokalemia with kaliuresis, elevated plasma aldosterone concentration (PAC), suppressed plasma renin concentration, and a high aldosterone-to-renin ratio. Both patients did not have sufficiently suppressed PAC on the saline infusion test, confirming the diagnosis of PA. Computed tomography of the adrenal gland and adrenal venous sampling suggested an aldosteronoma, which was confirmed by lateralized hypersecretion of aldosterone. After removal of the benign adenoma, the biochemical abnormalities were corrected. As hypertension is not necessarily a sign of PA, we propose that all patients with hypokalemia should be screened for PA in order to prevent cardiovascular complications while balancing economics and effectiveness.

Case series: Primary aldosteronism diagnosed despite normal screening investigations: A report of three cases

“…Although the ARR can be increased even in the absence of a suppressed plasma renin, this possibility should be kept in mind while performing the diagnostic workup of PA even in normotensive patients, and appropriate use of well-established confirmatory tests should be considered. [29] Finally, we summarize some experience gained from these cases and some hints for future clinical work. It is important to recognize that PA patients with non-suppressed renin, hence a negative diagnosis ARR, exist.…”

“…Although the ARR can be increased even in the absence of a suppressed plasma renin, this possibility should be kept in mind while performing the diagnostic workup of PA even in normotensive patients, and appropriate use of well-established confirmatory tests should be considered. [ 29 ]…”

Prolactinoma asociada a hiperaldosteronismo primario: ¿existe una relación entre ambas entidades?

“…Presentamos el caso de una mujer adulta de 38 años con diagnóstico de prolactinoma y AP, donde la coexistencia entre ambas entidades ya ha sido descrita en la literatura, pero sigue siendo una condición raramente reportada (11)(12)(13)(14).…”

“…Por su parte, Jia et al (13) reportaron dos pacientes con AP normotensivo. De manera similar a nuestro caso, el paciente 2 se asoció a la presencia concomitante de un prolactinoma y donde ninguno de estos pacientes tuvo hipertensión detectable en repetidas mediciones manuales, no obstante, en ambos pacientes se demostró un perfil bioquímico típico del AP con una PRA suprimida, una alta concentración de aldosterona en plasma y una relación aldosterona/PRA elevada.…”

“…La presencia de prolactinomas en asociación simultanea con AP ha sido escasamente reportada en la literatura, sin embargo, llama la atención el número recurrente de casos con prolactinoma-AP concurrente (11)(12)(13). A continuación, se presenta un caso infrecuente de prolactinoma-AP coexistente con el objetivo de destacar la ocurrencia conjunta de ambas entidades y exponer, según la evidencia actual disponible, el potencial vínculo fisiopatológico entre la hiperprolactinemia/prolactinoma y el AP.…”