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Kidney Week

Abstract: SA-PO690

Nephrolithiasis as a Manifestation of Primary Hyperaldosteronism Secondary to Adrenal Adenoma

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • de la Vega Méndez, Frida Margarita, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
  • Arteaga Muller, Giovanna Y., Christus Muguerza Sistemas Hospitalarios SA de CV, Monterrey, Nuevo Leon, Mexico
Introduction

The primary hyperaldosteronism has been considered a rare cause of secondary hypertension with a prevalence up to 12%. The variability of presentation of this syndrome is too wide and sometimes it is not the usual one. The following is a case of a patient who started with hypertension and recurrent kidney calculi due to primary hyperaldosteronism caused by an adrenal adenoma.

Case Description

33 years-old male with no significant medical history who presented to hospital due to hypertensive episodes. Outpatient laboratory tests were performed and hypokalemia plasma renin activity was requested and reported 0.39 and aldosterone at 20. Primary hyperaldosteronism was suspected. After that the patient begins with intermittent episodes of lower abdominal pain, irradiated to right groin and hematuria. Laboratory tests creatinine 0.77 urea 21 Na 145 k 2.5. A renal Doppler ultrasound was performed and reported bilaterally renal calculi the intrarenal circulation was in normal parameters in both kidneys. Abdominal tomography was practiced where bilateral renal lithiasis is observed and a stone in the upper third of the right ureter of 3.2 mm diameter. A ureterolithotomy was performed the analysis of the calculus reported 60% calcium oxalate 40% calcium phosphate. During the following 4 years the patient continued with episodes of urolithiasis without other alterations In the last episode the patient presented again in the emergency room due to abdominal pain and a well-defined hypodense nodular image towards the left adrenal gland was found in the abdominal tomography related to adenoma and multiple intrarenal stones microcysts and simple cysts were observed with presence of free intravesical stones. The patient received medical management and lithotripsy was performed after 1 month a laparoscopic radical left adrenalectomy was performed without complications.

Discussion

There are few cases reported in the literature of patients with primary hyperaldosteronism and recurrent nephrolithiasis. It has been reported that chronic mineralocorticoid administration and primary hyperaldosteronism facilitate renal calcium excretion. This case alerts us of the importance to remember the renal physiology of calcium in hyperaldosteronism and it is one of the most variable presentations and for which the patient will seek medical attention quickly.