Kidney Week

Abstract: PUB109

When Trauma Uncovers Adenomas: A Case of Unmasked Primary Hyperaldosteronism

Session Information

• Publication Only

Category: Fluid, Electrolytes, and Acid-Base Disorders

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

Authors

• Del Valle Vega, Sarybell J., Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico

Sarybell J. Del Valle Vega, MD, MBA

• Vazquez Morales, Emily, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico

Emily Vazquez Morales, MD

• Ocasio Melendez, Ileana E., Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico

Ileana E. Ocasio Melendez, MD, FASN

• Rivera Rios, Jeaneishka Marie, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico

Jeaneishka Marie Rivera Rios, MD

Introduction

Evaluating causes of hypertension in young patients constitutes assessing both lifestyle factors and secondary causes. In relatively young patients, Primary Hyperaldosteronism (PH) has been frequently overlooked as a cause of hypertension, particularly when trauma presentation complicates classical presentation of disease. When unilateral adenomas are present, surgery is prioritized, but medical therapy can be considered as first-line management in selective patients with unusual high suspicion of PH.

Case Description

A 44 year-old male without medical history was admitted to the Trauma unit after sustaining a crush injury to arm. Admission vital signs consisted of hypertension of 214/101 mmHg. Laboratory evaluation demonstrated severe hypokalemia (2 mmol/L), metabolic alkalosis (CO2 at 30.6 mmol/L), and increased serum creatinine (2.22 mg/dL). Urine analysis pointed to renal potassium wasting (FEK = 7.9%). Abdomen/Pelvis CT revealed an indeterminate left adrenal nodule measuring approximately 1.4 cm in greatest diameter. Despite use of first-line antihypertensives, patient had persistent hypertension (182/79 mmHg), decreasing hypokalemia (2.1 mmol/L), and worsening renal function at 2.11 mg/dL. Nephrology service was consulted and suspicion remained high at PH pathology. Mineralocorticoid receptor antagonist (MRA) therapy was started leading to improvement of blood pressure averaging between 120-140/71-90 mmHg. Potassium levels improved to 4.1 mmol/L, and serum creatinine returned to near baseline (1.26 mg/dL). Given that need for urgent patient stabilization, plasma aldosterone and direct renin concentration levels were re-tested due to inconclusive first-set of values. After monitored improvement was observed patient was eventually discharged from facility.

Discussion

Diagnosing unexplained causes of hypertension can be challenging, particularly physiologic stress may obscure underlying endocrine disorders. When PH suspicion is high in patients with adrenal adenomas and classical features, it is important to consider re-testing when needed to clarify diagnosis. Medical therapy with MRAs can be selected in patients with uncontrolled hypertension in which surgical procedures cannot be performed due to extent of existing injuries from previous trauma.