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Title: Persistent hypoaldosteronism post-adrenalectomy for primary aldosteronism - a role for pre-operative spironolactone?
Austin Authors: Angus, Lachlan M ;Yang, Jun;Cheung, Ada S 
Affiliation: Medicine (University of Melbourne)
Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
Department of Medicine, Monash University, Victoria, Australia
Issue Date: 1-Oct-2021
Date: 2021-10-01
Publication information: Endocrinology, Diabetes & Metabolism Case Reports 2021; online first: 1 October
Abstract: Primary aldosteronism is one of the most common (affecting up to 10%) yet treatable causes of hypertension in our community, notable due to an associated elevated risk of atrial fibrillation, stroke and myocardial infarction compared to essential hypertension. Guidelines have focussed on improving case detection due to significant underdiagnosis in the community. While our case experienced significant delay in diagnosis, we highlight a state of protracted, persistent post-operative hypoaldosteronism which manifested with severe hyponatraemia and hyperkalaemia, necessitating long-term mineralocorticoid replacement. We discuss whether pre-operative mineralocorticoid receptor antagonists to stimulate aldosterone secretion from the contralateral gland may have prevented this complication. Hypoaldosteronism is an uncommon complication of adrenalectomy for primary aldosteronism, typically manifesting with hyperkalaemia and hyponatraemia. While most cases are transient, it may be persistent, necessitating ongoing mineralocorticoid replacement. Routine electrolyte monitoring is recommended post-adrenalectomy. Risk factors for hypoaldosteronism include age >50 years, duration of hypertension >10 years, pre-existing renal impairment and adrenal adenoma size >2 cm. Mineralocorticoid receptor antagonists may assist in the management of hypokalaemia and hypertension pre-operatively. However, it is unclear whether this reduces the risk of post-operative hypoaldosteronism.
DOI: 10.1530/EDM-21-0137
ORCID: 0000-0002-5842-6173
Journal: Endocrinology, Diabetes & Metabolism Case Reports
PubMed URL: 34695011
ISSN: 2052-0573
Type: Journal Article
Appears in Collections:Journal articles

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