Acil Serviste İhmal Edilen Bir Hipertansiyon Nedeni: Primer Hiperaldosteronizm

Abstract

Primer hiperaldosteronizm (PHA) dirençli hipertansiyon önde gelen nedenlerinden biridir. Bu yazıda acil servise dirençli hipertansiyon ve kas güçsüzlüğü ile başvuran 57 yaşında bir kadın hasta sunuldu. Elli yedi yaşındaki hipertansif kadın hasta kas güçsüzlüğü ve dirençli hipertansiyon ile acil servise başvurdu. İlk fizik muayene ve laboratuvar incelemesinde yüksek kan basıncı (232/136 mmHg), kas güçsüzlüğü, hipokalemi (K+=2.1 meq/l) ve metabolik alkaloz (pH=7.47) saptandı. Acil Serviste uygulanan ilk tedaviden sonuç alınamadı. Dirençli hipokalemi, metabolik alkaloz ve arteryel hipertansiyon nedeniyle, hastada PHA dan şüphe edilerek hasta hastaneye yatırıldı. Elde edilen, plazma rennin aktivitesi 0.3 ng/ml/saat (normal değerler 0.2-2.8 ng/ml/saat) Plazma aldosteron konsantrasyonu 534.41 pg/ml (normal değerler: 10-160 ml/ pg) ve aldosteron konsantrasyonu/Renin Aktivitesi/oranı 178 ng/ dl/ng/ml/h bulundu. Batın tomografisi normaldi. Hastaya günlük 100 mg Aldactazid tedavisi uygulandı. İki hafta normal kan basıncı ve K+ düzeyi ile hasta taburcu edildi. PHA dirençli hipertansiyonun önde gelen nedenlerinden biridir. Acil hekimi hipokalemi ve metabolik alkalozun eşlik ettiği dirençli hipertansiyona sahip hastalarda erken tanı ve kardiyovasküler komplikasyonlardan korunmak için PHA’i tanıda düşünmelidir.

Keywords

• Hipertansiyon, hiperaldosteronizm, acil servis

A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism

Abstract

Primary hyperaldosteronism (PHA) is one of the leading causes of persistent hypertension. In this paper, we report the case of a 57-year-old woman who presented at our emergency department (ED) with muscle weakness and persistent hypertension. The initial examination revealed high blood pressure (232/136 mmHg), muscle weakness, hypokalemia (K+=2.1 mEq/L), and metabolic alkalosis (pH=7.47). Initial ED therapy failed. Because persistent hypokalemia and arterial hypertension with metabolic alkalosis raised the suspicion of PHA, we obtained measurements of renin activity (0.3 ng/ml/h, normal values: 0.2-2.8 ng/ml/h), aldosterone concentration (534.41 pg/ml, normal values: 10-160 pg/ml) and the ratio of aldosterone concentration/renin activity (178 ng/dl/ng/ml/h). There was no surrenal adenoma on the abdominal computerized tomography. The patient was administered a daily 100 mg dose of aldactazide. At the end of two weeks, the patient was discharged with normal blood pressure and K+ level. PHA is one of the leading causes of persistent hypertension. The emergency physician should pay close attention to patients with hypokalemia and metabolic alkalosis accompanying symptoms such as persistent hypertension, in order to diagnosis PHA early and reduce cardiovascular complications

Keywords

• Emergency departments, hyperaldosteronism, hypertension

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