1/10. Primary aldosteronism with aldosterone-producing adrenal adenoma in a pregnant woman.A 30-year-old pregnant woman complained of muscle weakness at 29 weeks' gestation. She was hypertensive with severe hypokalemia. Lower plasma renin activity and higher aldosterone level than the normal values in pregnancy suggested primary aldosteronism. A cesarean delivery was performed at 31 weeks' gestation because of pulmonary congestion. The neonatal course was uncomplicated. The laparoscopic adrenalectomy for a 2.0-cm right adrenal adenoma resulted in normalizing of her blood pressure and serum potassium level. Although primary aldosteronism is rare, especially during pregnancy, it should be always considered as one of etiologies of hypertension in pregnancy.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
2/10. Primary aldosteronism caused by aldosterone-producing adenoma in pregnancy--complicated by EPH gestosis.pregnancy in conjunction with primary aldosteronism is an unusual occurrence. We report a 28-year-old woman who presented with mild hypertension and hypokalemia as manifestations of primary aldosteronism caused by an aldosterone-producing adenoma in the left adrenal gland during pregnancy. Although the diagnosis was straightforward, the patient refused to undergo the proposed operation during the second trimester of her pregnancy. She was not admitted to hospital until she developed EPH gestosis in the 27th week of gestation, which had an unfavourable outcome for the infant who died nine days after delivery. The patient underwent a laparoscopic adrenalectomy which resulted in normalization of blood pressure and blood potassium levels. In cases of aldosterone-producing adenoma, surgery in the second trimester is the most appropriate option to avoid a poor obstetric outcome.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
3/10. Laparoscopic adrenalectomy for primary hyperaldosteronism during pregnancy.Laparoscopic adrenalectomy was performed early in the second trimester of pregnancy in a woman with an aldosteronoma causing hypertension (254/154 mm Hg). The patient was later delivered of a healthy baby. With suitable precautions and timing, major laparoscopic surgery can be performed safely during pregnancy.- - - - - - - - - - ranking = 0.66666666666667keywords = aldosteronism (Clic here for more details about this article) |
4/10. Laparoscopic adrenalectomy on a patient with primary aldosteronism during pregnancy.A pregnant 26-year-old woman was referred for evaluation and management of progressive hypertension and hypokalemia at 14 weeks of gestation. Her plasma aldosterone level was markedly elevated and magnetic resonance imaging showed a right adrenal tumor. Primary aldosteronism due to an aldosterone producing-adenoma was diagnosed. Because of progressive severe hypertension, a laparoscopic adrenalectomy was performed at 17 weeks of gestation. The procedure was completed without complication, and plasma aldosterone and potassium levels rapidly improved post-operatively. However, her hypertension persisted and the growth retardation of the fetus was found. Regrettably, intrauterine fetal death was confirmed at 26 weeks of gestation. Histological examination of the placenta revealed that the placental artery had very thick walls which had apparently caused a critical failure in fetal blood flow. The optimal timing of laparoscopic surgery during pregnancy and perioperative management were subsequently discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = aldosteronism (Clic here for more details about this article) |
5/10. Primary hyperaldosteronism in pregnancy.A case is reported of a primigravid woman presenting in midgestation with severe hypertension caused by primary hyperaldosteronism. Symptomatic treatment with an aldosterone blocker, a peripheral vasodilator, and a combined alpha beta-blocker allowed pregnancy to continue to 36 weeks' gestation. cesarean section for fetal distress resulted in delivery of a dysmature female infant who did well. Further postpartum studies confirmed the presumptive diagnosis made during pregnancy. An adenoma, localized in the right adrenal gland, was surgically removed.- - - - - - - - - - ranking = 0.83333333333333keywords = aldosteronism (Clic here for more details about this article) |
6/10. Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism.This is a case report of a 37-year-old Japanese woman with primary aldosteronism who was found to have high plasma renin activity during toxemia of pregnancy and who died of a dissecting aneurysm of the aorta about 2 years later. The autopsy findings showed cystic medial necrosis in the aorta and a right adrenocortical adenoma. The dissecting aneurysm in this case is probably related to hypertension and cystic medial necrosis. A definite diagnosis of primary aldosteronism cannot be made during toxemia of pregnancy, and it is necessary to do serial determinations of plasma renin activity and plasma aldosterone concentration after delivery to confirm the diagnosis.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
7/10. aldosterone-producing-adenoma (A-P-A): effect of pregnancy.Serial measurements of plasma renin activity, plasma progesterone and urinary aldosterone were made before, during and after pregnancy in a patient from whom an A-P-A was later removed with cure of hypertension and hypokalemia. Despite 16-fold increases in urinary aldosterone during pregnancy, plasma renin activity levels became unsuppressed, and hypertension and hypokalemia were reversed. Increases in plasma progesterone or other steroids, competitively inhibiting the effects of aldosterone on its receptor, may explain remission of A-P-A and reversal of renin suppression during pregnancy. In a second patient, the features of primary aldosteronism appeared immediately after a pregnancy, and removal of an A-P-A cured hypertension and hypokalemia. A-P-A is more common in females and may appear following pregnancy. Urinary aldosterone was 6-fold higher after pregnancy than before. Thus, sex steroids may not only protect from hyperaldosteronism but may also stimulate growth of A-P-A's.- - - - - - - - - - ranking = 0.33333333333333keywords = aldosteronism (Clic here for more details about this article) |
8/10. Primary hyperaldosteronism in pregnancy.We report a case of primary hyperaldosteronism in a 37-year-old woman presenting early in pregnancy with hypertension and hypokalaemia. plasma renin concentration was suppressed and unaffected by sodium restriction or upright posture at 16 and 35 weeks gestation, or seven days post-partum. Recumbent plasma aldosterone was elevated, and normal postural response lost both at 35 weeks gestation and seven days post-partum. Vaginal delivery, following induction at 38 weeks, was uncomplicated. Two months postpartum C.T. scan and adrenal venous catheterisation studies indicated a left sided adenoma and left adrenalectomy was performed. Within seven days the patient was normotensive with normal serum potassium and urinary aldosterone on no treatment.- - - - - - - - - - ranking = 0.83333333333333keywords = aldosteronism (Clic here for more details about this article) |
9/10. diagnosis and surgical treatment of primary aldosteronism in pregnancy: a case report.BACKGROUND: aldosterone-producing adrenal adenomas are rare, especially during pregnancy. We report a patient who presented in the early second trimester, was diagnosed with primary aldosteronism, and was treated successfully by adrenalectomy. CASE: A 17-year-old black nulliparous woman was found to have a blood pressure (BP) of 150/82 mmHg when she registered for prenatal care at 14 weeks' gestation. Initial laboratory assessment revealed a markedly diminished serum potassium level of 2.1 mmol/L. Further laboratory evaluation detected decreased random plasma renin activity and an elevated aldosterone level. magnetic resonance imaging revealed a 2-cm right adrenal lesion. She was diagnosed with an adrenal adenoma and successfully underwent an adrenalectomy at 17 weeks' gestation. Postoperatively, her BP and serum potassium level normalized. She spontaneously delivered a normal male infant at term. CONCLUSION: Although primary hyperaldosteronism is a rare clinical entity, it must be considered when hypertension and hypokalemia are present concurrently. Antepartum medical management can be difficult, often resulting in poor obstetric outcome. Surgery in the second trimester is an effective option.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
10/10. Primary aldosteronism in pregnancy--should it be treated surgically?We report a case of primary aldosteronism in pregnancy that was treated surgically by removal of the adenoma in the 2nd trimester. Only a few cases have been reported in the English literature due to the rarity of the condition. Primary aldosteronism follows a variable course in pregnancy. In the majority of cases the hypertension and hypokalaemia are made worse, necessitating antihypertensive medication to control the blood pressure. Some of the drugs required for treatment are known to affect the fetus. In a minority of cases the hypertension improves with pregnancy. This is thought to be due to the high levels of progesterone which is an aldosterone antagonist. Primary aldosteronism invariably gets worse in the post partum period, irrespective of the antenatal course of the disease. Surgery seems to be the treatment of choice for this condition, provided the adenoma is localised. It has the advantage of offering an immediate solution, avoids fetal complications of medical treatment and possible deterioration in the post partum period.- - - - - - - - - - ranking = 1.1666666666667keywords = aldosteronism (Clic here for more details about this article) |
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