Abstract: PUB036
Point-of-Care Ultrasound-Guided Care in Primary Aldosteronism Presenting with Intracerebral Hemorrhage
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Patel, Rujuta, Lenox Hill Hospital, New York, New York, United States
- Lee, Crystal, Lenox Hill Hospital, New York, New York, United States
- Moses, Andrew A., Lenox Hill Hospital, New York, New York, United States
Introduction
Resistant hypertension contributes to chronic kidney disease (CKD) and cerebrovascular event. Primary aldosteronism is a frequently overlooked cause of secondary hypertension. Even without hypokalemia, early recognition is critical to prevent kidney and end-organ damage. Point-of-care ultrasound (POCUS) can guide secondary hypertension workup and medication management in acute settings.
Case Description
A 62-year-old woman with untreated hypertension presented with two days of headache and left upper extremity weakness. On arrival, blood pressure was 220/120 mmHg. Neurologic exam revealed left upper extremity drift, decreased sensation, and dysmetria. CT head showed intraparenchymal hemorrhage, and nicardipine infusion was initiated. Creatinine was 1.48 mg/dL, concerning for AKI versus undiagnosed CKD, however sodium, potassium, and bicarbonate remained normal through admission.
Despite amlodipine, hydralazine, hydrochlorothiazide, and labetalol, hypertension persisted, prompting nephrology consultation. POCUS demonstrated low intravascular volume with hyperdynamic and hypertrophic left ventricle and flat IVC, prompting further secondary evaluation and hydrochlorothiazide was discontinued. Workup revealed elevated aldosterone-to-renin ratio of 55 with suppressed plasma renin, concerning for primary aldosteronism. Addition of spironolactone improved blood pressure control, kidney function remained stable, and CKD was attributed to hypertensive nephrosclerosis driven by hyperaldosteronism.
Discussion
This case highlights the importance of considering primary aldosteronism in resistant hypertension without hypokalemia. POCUS served as a bedside tool for volume assessment, helping avoid inappropriate diuresis and guide antihypertensive titration in CKD. Primary aldosteronism is a common yet underdiagnosed cause of resistant hypertension that can lead to end-organ damage. Early identification and targeted management, complemented by POCUS, are essential to optimize blood pressure control and preserve kidney function.