Unmasking of primary hyperaldosteronism by renal transplantation

Background. Primary hyperaldosteronism is an uncommon cause of hypertension in the general population. Given the mechanism of action of aldosterone cl inical manifestations may not occur in the setting of end stage renal disea se. However, if a successful renal transplant is performed clinical manifes tations may occur. Methods. We present a case of a patient with a preexisting adrenal adenoma who only presented with clinical signs of hyperaldosteronism after renal tr ansplantation. Patients' work-up included plasma aldosterone, plasma renin activity, serum cortisol, and estimation of trans tubular potassium gradien t. Results. The patient's serum aldosterone was markedly elevated with a relat ively suppressed plasma renin activity. Trans tubular potassium gradient wa s high in the presence of hypokalemia. Conclusion. Previously silent hyperaldosteronism may be unmasked by a succe ssful renal transplant.