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2018 ; 7
(1
): 77-82
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Complete remission of hypertension in a hemodialysis patient after adrenalectomy
for primary aldosteronism and renal transplantation
#MMPMID29288290
Watanabe D
; Morimoto S
; Takano N
; Kimura S
; Seki Y
; Bokuda K
; Sasaki-Yatabe M
; Yatabe J
; Onizuka H
; Yamamoto T
; Ando T
; Ichihara A
CEN Case Rep
2018[May]; 7
(1
): 77-82
PMID29288290
show ga
A 64-year-old man was admitted to our hospital for the hormonal evaluation of a
right adrenal adenoma. He had been diagnosed with severe proteinuria and
hypertension, and antihypertensive treatment was started at the age of 60. His
renal function gradually declined, and hemodialysis was begun at the age of 64.
Since his blood pressure was uncontrollable and resistant to antihypertensive
treatment, an endocrinological examination was performed for an incidental right
adrenal mass detected by computed tomography. The results of screening, including
captopril challenge and an adrenocorticotropin stimulation test for primary
aldosteronism, and adrenal venous sampling suggested excessive aldosterone
secretion from the right adrenal gland. Adrenalectomy was performed; his blood
pressure decreased and became well-controlled with a reduced antihypertensive
regimen. Furthermore, he received renal transplantation which resulted in
normalization of his serum potassium level, improvement of renal function and
hormonal levels such as plasma renin activity and aldosterone concentration, and
satisfactory blood pressure without any antihypertensive medications. This case
is extremely important to demonstrate the effects of adrenalectomy for primary
aldosteronism in a hemodialysis patient. It is possible that adrenalectomy may be
a useful treatment for primary aldosteronism even in patients undergoing
hemodialysis. Careful long-term follow-up of our case and investigations of the
efficacy of adrenalectomy in similar cases are needed to address this issue.
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