BibTex RIS Kaynak Göster

Acil Serviste İhmal Edilen Bir Hipertansiyon Nedeni: Primer Hiperaldosteronizm

Yıl 2012, Cilt: 3 Sayı: 2, 46 - 48, 01.04.2012

Melih Yüksel Serkan Yılmaz Murat Pekdemir Elif Yaka

Öz

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.

Anahtar Kelimeler

Hipertansiyon hiperaldosteronizm acil servis

Kaynakça

  • Börgel J, Springer S, Ghafoor J, Arndt D, Duchna HW, Barthel A, et al. Un- recognized secondary causes of hypertension in patients with hyper- tensive urgency/emergency: prevalence and co-prevalence. Clin Res Cardiol 2010; 99: 499-506. [CrossRef]
  • Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, et al. Vas- cular remodeling and duration of hypertension predict outcome of ad- renalectomy in primary aldosteronism patients. Hypertension. 2008; 51: 1366-71. [CrossRef]
  • Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, et al. Discrimina- ting factors for recurrent hypertension in patients with primary aldostero- nism after adrenalectomy. Hypertens Res 2002; 25: 11-8. [CrossRef]
  • Mulatero P, Monticone S, Bertello C. Evaluation of primary aldostero- nism. Curr Opin Endocrinol Diabetes Obes 2010; 17: 188-93. [CrossRef]
  • Nyirendaa JM, Padfield PL. Aldosterone and refractory hypertension. Curr Opin Endocrinol Diabetes Obes 2007; 14: 213-8. [CrossRef]
  • Kaplan NM. Is There an Unrecognized Epidemic of Primary Aldostero- nism? (Con). Hypertension 2007; 50: 454-8. [CrossRef]

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

Yıl 2012, Cilt: 3 Sayı: 2, 46 - 48, 01.04.2012

Melih Yüksel Serkan Yılmaz Murat Pekdemir Elif Yaka

Öz

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

Anahtar Kelimeler

Emergency departments hyperaldosteronism hypertension

Kaynakça

  • Börgel J, Springer S, Ghafoor J, Arndt D, Duchna HW, Barthel A, et al. Un- recognized secondary causes of hypertension in patients with hyper- tensive urgency/emergency: prevalence and co-prevalence. Clin Res Cardiol 2010; 99: 499-506. [CrossRef]
  • Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, et al. Vas- cular remodeling and duration of hypertension predict outcome of ad- renalectomy in primary aldosteronism patients. Hypertension. 2008; 51: 1366-71. [CrossRef]
  • Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, et al. Discrimina- ting factors for recurrent hypertension in patients with primary aldostero- nism after adrenalectomy. Hypertens Res 2002; 25: 11-8. [CrossRef]
  • Mulatero P, Monticone S, Bertello C. Evaluation of primary aldostero- nism. Curr Opin Endocrinol Diabetes Obes 2010; 17: 188-93. [CrossRef]
  • Nyirendaa JM, Padfield PL. Aldosterone and refractory hypertension. Curr Opin Endocrinol Diabetes Obes 2007; 14: 213-8. [CrossRef]
  • Kaplan NM. Is There an Unrecognized Epidemic of Primary Aldostero- nism? (Con). Hypertension 2007; 50: 454-8. [CrossRef]
Toplam 6 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA84KS29EA
Bölüm Case Report
Yazarlar

Melih Yüksel Bu kişi benim

Serkan Yılmaz Bu kişi benim

Murat Pekdemir Bu kişi benim

Elif Yaka Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2012
Gönderilme Tarihi 1 Nisan 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 3 Sayı: 2

Kaynak Göster

APA Yüksel, M., Yılmaz, S., Pekdemir, M., Yaka, E. (2012). A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism. Journal of Emergency Medicine Case Reports, 3(2), 46-48.
AMA Yüksel M, Yılmaz S, Pekdemir M, Yaka E. A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism. Journal of Emergency Medicine Case Reports. Nisan 2012;3(2):46-48.
Chicago Yüksel, Melih, Serkan Yılmaz, Murat Pekdemir, ve Elif Yaka. “A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism”. Journal of Emergency Medicine Case Reports 3, sy. 2 (Nisan 2012): 46-48.
EndNote Yüksel M, Yılmaz S, Pekdemir M, Yaka E (01 Nisan 2012) A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism. Journal of Emergency Medicine Case Reports 3 2 46–48.
IEEE M. Yüksel, S. Yılmaz, M. Pekdemir, ve E. Yaka, “A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism”, Journal of Emergency Medicine Case Reports, c. 3, sy. 2, ss. 46–48, 2012.
ISNAD Yüksel, Melih vd. “A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism”. Journal of Emergency Medicine Case Reports 3/2 (Nisan 2012), 46-48.
JAMA Yüksel M, Yılmaz S, Pekdemir M, Yaka E. A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism. Journal of Emergency Medicine Case Reports. 2012;3:46–48.
MLA Yüksel, Melih vd. “A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism”. Journal of Emergency Medicine Case Reports, c. 3, sy. 2, 2012, ss. 46-48.
Vancouver Yüksel M, Yılmaz S, Pekdemir M, Yaka E. A Neglected Cause of Hypertension in the Emergency Department: Primary Hyperaldosteronism. Journal of Emergency Medicine Case Reports. 2012;3(2):46-8.