PRIMARY HYPERALDOSTERONISM IN PREGNANCY - A CASE-REPORT

BACKGROUND: Primary hyperaldosteronism is an uncommon disorder, and th ere are few reports of its occurrence and management in pregnancy. CAS E: Primary hyperaldosteronism was suspected before pregnancy in a 31-y ear-old woman with refractory hypertension and hypokalemia. Prepregnan cy evaluation revealed suppressed renin levels and high aldosterone le vels; computed tomography revealed a 1-cm mass in the left adrenal gla nd. The patient became pregnant before completion of evaluation and tr eatment. On high doses of nifedipine and nadolol, the first-trimester blood pressure was 130/98 mm Hg and remained high in the early second trimester. In view of the risks of poorly controlled hypertension, adr enalectomy was performed at 15 weeks' gestation, with rapid improvemen t in blood pressure and elimination of the patient's requirement for l arge doses of potassium daily. Antihypertensive medication was withdra wn, with maintenance of normal blood pressure until 36 weeks' gestatio n. At that time the blood pressure rose slightly but responded to bed rest. A healthy female infant was delivered at term by cesarean sectio n. CONCLUSION: Previous reports of emergency preterm delivery and a ca se of neonatal mortality in the setting of hyperaldosteronism in pregn ancy confirm the significant risks associated with this condition. In our patient, adrenalectomy in the early second trimester resulted in a rapid and sustained improvement in hypertension, reversal of hypokale mia and a good pregnancy outcome.