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A Case of Primary Aldosteronism Misdiagnosed for Many Years

瑶石 梦
Published: 1 January 2022

Abstract: A 60-year-old male patient was admitted to the Department of Cardiovascular Medicine of our hos-pital because of chest tightness and suffocation for more than half a year after emotional agitation, accompanied by palpitation, dizziness and headache. He has a history of hypertension for 13 years and has been regularly taking “valsartan amlodipine tablets” for hypotensive for many years. His blood pressure has never been well controlled during the medication, with the highest value being 200/100 mmHg, with 10 years after intracranial aneurysm embolization for subarachnoid hemor-rhage, and half a year after retinal detachment in the right eye. The patient denied smoking and drinking history, family history of cardiovascular disease and early onset hypertension. On admis-sion, heart rate was 65 times/min, blood pressure was 155/99 mmHg, general condition and con-ventional physical examination were negative. The results of blood potassium and blood sodium were 1.6 mmol/L and 147.8 mmol/L, respectively. Urine analysis showed PH 6.0, and plasma al-dosterone levels increased in vertical position 511 pg/mL and recubitus position 655 pg/mL re-spectively. The plasma renin activity was decreased by 0 ng/mL/hr in vertical position and 0 ng/mL/hr in recubitus position, and the aldosterone/renin activity ratio (ARR) was increased by 51.1 in vertical position and 65.5 in recubitus position. Dynamic enhanced adrenal CT scan showed low- density nodular opacity in both adrenal glands, which was considered as primary aldosteron-ism caused by adrenal cortical adenoma. Then, the patient was transferred to the urology depart-ment for retroperitoneal laparoscopic left adrenal gland resection, which was pathologically diag-nosed as adrenal cortical adenoma. The plasma aldosterone, blood potassium, blood sodium and other biochemical indexes were all in the normal range and blood pressure was normal 2 weeks af-ter surgery.
Keywords: blood pressure / adrenal / recubitus / primary aldosteron / blood sodium / Cardiovascular / history / Department / aldosterone

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