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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 06

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Ginecol Obstet Mex 2022; 90 (06)

Management of primary hyperaldosteronism during pregnancy: Case report

Paz-Ibarra J, Siura-Trevejo G, García-Ruiz V, Somocurcio-Peralta J

Language: Spanish
References: 24
Page: 530-537
PDF size: 234.49 Kb.


ABSTRACT

Background: Primary hyperaldosteronism is the main cause of arterial hypertension of endocrine origin in the general population; its presentation during pregnancy is infrequent; having described about 50 cases since 1962, the most common cause is the presence of an adrenal adenoma.
Objective: To report the first case of hyperaldosteronism treated during pregnancy in Peru and reviews the literature.
Clinical case: A 39-year-old patient with a history of arterial hypertension and poor obstetric history, who was referred to our center in the second trimester of the 5th pregnancy due to uncontrolled hypertension and symptomatic hypokalemia. Management included an aldosterone receptor antagonist, allowing the control of blood pressure and the culmination of the pregnancy with the delivery of a healthy girl. Subsequently, the presence of an adrenal nodule was confirmed, the resection of which resulted in normalization of aldosterone concentration, plasma renin activity, kalemia, and remission of hypertension to date.
Conclusion: Recommendations on the management of hyperaldosteronism during pregnancy are based only on published cases and drug toxicity data were generated in animal studies. Hence the importance of this report, which provides information that can be considered in similar situations.


REFERENCES

  1. Corsello SM, Paragliola RM. Evaluation and Managementof Endocrine Hypertension During Pregnancy. EndocrinolMetab Clin North Am 2019; 48(4): 829-42. doi: 10.1016/j.ecl.2019.08.011

  2. Alvarez M, Manzanares M. Aldosteronismo primario. En:Bellver J, Fontes J, Acevedo B. Patologías endocrinas debaja prevalencia. 1ª ed. Madrid: Editorial Médica Panamericana,2016; 39-52.

  3. Funder JW, Carey RM, Mantero F, Murad MH, et al. Themanagement of primary aldosteronism: case detection,diagnosis, and treatment: an endocrine society clinicalpractice guideline. J Clin Endocrinol Metab 2016; 101 (5):1889-916. doi: 10.1210/jc.2015-4061

  4. Morton A. Primary aldosteronism and pregnancy. PregnancyHypertens 2015; 5 (4): 259-62. doi: 10.1016/j.preghy.2015.08.003

  5. Riester A, Reincke M. Progress in primary aldosteronism:mineralocorticoid receptor antagonists and managementof primary aldosteronism in pregnancy. Eur J Endocrinol2015; 172 (1): R23-30. doi: 10.1530/EJE-14-0444

  6. Escher G. Hyperaldosteronism in pregnancy.Ther Adv Cardiovasc Dis 2009; 3 (2): 123-32. doi:10.1177/1753944708100180

  7. Irani RA, Xia Y. The functional role of the renin-angiotensinsystem in pregnancy and preeclampsia. Placenta 2008; 29(9): 763-71. doi: 10.1016/j.placenta.2008.06.011

  8. Kamoun M, Mnif MF, Charfi N, Kacem FH, et al. Adrenaldiseases during pregnancy: pathophysiology, diagnosisand management strategies. Am J Med Sci 2014; 347 (1):64-73. doi: 10.1097/MAJ.0b013e31828aaeee

  9. Abdelmannan D, Aron DC. Adrenal disorders in pregnancy.Endocrinol Metab Clin North Am 2011; 40 (4):779-94. doi:

  10. 10.1016/j.ecl.2011.09.00110. Sabbadin C, Andrisani A, Ambrosini G, Bordin L, et al. Aldosteronein gynecology and its involvement on the riskof hypertension in pregnancy. Front Endocrinol (Lausanne)2019; 23 (10): 575. doi: 10.3389/fendo.2019.00575

  11. Lu W, Zheng F, Li H, Ruan L. Primary aldosteronism andpregnancy: a case report. Aust N Z J Obstet Gynaecol 2009;49 (5): 558. doi: 10.1111/j.1479-828X.2009.01051.x

  12. Monticone S, D'Ascenzo F, Moretti C, Williams TA, et al.Cardiovascular events and target organ damage in primaryaldosteronism compared with essential hypertension:a systematic review and meta-analysis. Lancet DiabetesEndocrinol 2018; 6 (1): 41-50. doi: 10.1016/S2213-8587(17)30319-4

  13. Mehdi A, Rao P, Thomas G. Our evolving understandingof primary aldosteronism. Cleve Clin J Med. 2021; 88 (4):221-227. doi: 10.3949/ccjm.88a.20166

  14. Brown JM, Siddiqui M, Calhoun DA, Carey RM, et al. TheUnrecognized Prevalence of Primary Aldosteronism: ACross-sectional Study. Ann Intern Med 2020; 173 (1): 10-20. doi: 10.7326/M20-0065

  15. Landau E, Amar L. Primary aldosteronism and pregnancy.Ann Endocrinol (Paris) 2016; 77 (2): 148-60. doi: 10.1016/j.ando.2016.04.009

  16. Zhou J, Azizan EAB, Cabrera CP, Fernandes-Rosa FL, et al.Somatic mutations of GNA11 and GNAQ in CTNNB1-mutantaldosterone-producing adenomas presenting in puberty,pregnancy or menopause. Nat Genet 2021; 53 (9): 1360-1372. doi: 10.1038/s41588-021-00906-y

  17. Teo AE, Garg S, Shaikh LH, Zhou J, et al. Pregnancy, PrimaryAldosteronism, and Adrenal CTNNB1 Mutations.N Engl J Med 2015; 373 (15): 1429-36. doi: 10.1056/NEJMoa1504869

  18. Morton A. Primary aldosteronism and pregnancy. PregnancyHypertens 2015; 5 (4): 259-62. doi: 10.1016/j.preghy.2015.08.003

  19. Malha L, August P. Secondary Hypertension in Pregnancy.Curr Hypertens Rep 2015; 17 (7): 53. doi: 10.1007/s11906-015-0563-z

  20. Magee LA, Singer J, von Dadelszen P; CHIPS Study Group.Less-tight versus tight control of hypertension in pregnancy.N Engl J Med 2015; 372 (24): 2367-8. doi: 10.1056/NEJMc1503870

  21. Affinati AH, Auchus RJ. Endocrine causes of hypertensionin pregnancy. Gland Surg 2020; 9 (1): 69-79. doi: 10.21037/gs.2019.12.04

  22. Hecker A, Hasan SH, Neumann F. Disturbances in sexualdifferentiation of rat foetuses following spironolactonetreatment. Acta Endocrinol (Copenh) 1980; 95 (4): 540-5.doi: 10.1530/acta.0.0950540

  23. Rose LI, Regestein Q, Reckler JM. Lack of effect of spironolactoneon male genital development. Invest Urol 1975;13 (2): 95-6.

  24. Caretto A, Primerano L, Novara F, Zuffardi O, et al. TherapeuticChallenge: Liddle's Syndrome Managed with Amilorideduring Pregnancy. Case Rep Obstet Gynecol 2014;2014: 156250. doi: 10.1155/2014/156250




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