Abstract: SA-PO318
Late-Onset Presentation of Severe Hypokalemic Hypertension Resistant to Mineralocorticoid Antagonism
Session Information
- Hypertension and CVD: Mechanisms
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1403 Hypertension and CVD: Mechanisms
Authors
- Thimmisetty, Ravi K., Nephrology, Cape Girardeau, Missouri, United States
- Rossi, Noreen F., Wayne State University School of Medicine, Detroit, Michigan, United States
Introduction
We are presenting rare case of secondary hypertension who presented with muscle cramps and severe hypokalemia treated with ENaC (epithelium sodium channel) blocker
Case Description
A 45-year-old Caucasian lady was referred to clinic for management of refractory hypokalemia, uncontrolled blood pressure and metabolic alkalosis. She was complaining of intermittent muscle cramps. She was a healthy patient until 2017, when she was diagnosed with hypertension. Home medications were spironolactone 50 mg once daily, potassium chloride 20 mEq four times daily, clonidine 0.2 mg three times daily, lisinopril 20 mg once daily, amlodipine 10 mg, hydralazine 100 mg three times daily. There had been several emergency room visits for muscle cramps and uncontrolled blood pressure. Family history revealed mother died of heart attack at the age of 54 years. Father had problems of low potassium and a heart attack at a young age. Vitals revealed temperature of 98F, blood pressure 143/100 mmHg, heart rate 87 bpm, respiratory rate 16 per minute breathing on room air. Examination showed no edema and no abdominal bruits. Review of labs over the previous 2 months showed Na141-143, K 2.8-3.6, bicarbonate 23-27 mEq/L, BUN 6 mg/dL, creatinine 0.56 mg/dL,aldosterone 4.6 ng/dL and 5.4 ng/dL, plasma renin activity <0.6 ng/mL/h (checked twice), random cortisol was 0.6 – 4.6 ug/dL, urine potassium 13.5mEq/L. Renal ultrasound along with renal artery doppler, Echocardiogram, CT scan of head, MRI and MRA of the head and neck revealed with in normal findings. Stopped spironolactone and started amiloride 5 mg daily. Over the next few days, blood pressure dropped to ~100-120’s/60-80’s. Lisinopril, hydralazine, spironolactone and potassium supplements were stopped and clonidine was weaned off. Follow up labs in one week after starting amiloride showed potassium 4.2. Subsequently patient was advised to check blood pressure twice per day and closely followed
Discussion
Epithelial sodium channel blockade improved blood pressure and electrolyte abnormalities significantly suggesting either Liddle syndrome (autosomal dominant) or apparent mineralocorticoid excess (autosomal recessive) which typically present in childhood. Our case illustrates a rare cause of hypertension having at this age which is associated with hypokalemia and metabolic alkalosis that is not amenable to mineralocorticoid blockade