P50 | A paradigmatic case of secondary hypertension

L. Criscuolo¹, R. Ruocco², A. Piacevole², A. Villani², M. Del Core², A.I. Facciuto², A. Padula³, C. Carusone³, D. Cozzolino³, R. Nevola⁴ | ¹OORR Area Stabiese, Castellammare di Stabia (NA), ²Università degli Studi della Campania Luigi Vanvitelli, Napoli, ³AOU Vanvitelli, Napoli, ⁴AORN Moscati, Avellino, Napoli

Premises: Secondary hypertension recognizes an underlying disease from the distinct pathogenesis. Typical features of SH consist of younger age of onset, resistant hypertension, endocrine disorders.
Description of the Case report: A 58-years-old woman was admitted to emergency department for fatigue associated with severe hypokalemia. Her history included long-standing hypertension on triple combination therapy and obesity. Blood pressure was 170/90 mmHg; other vital parameters reported normal. Physical examination didn’t detect pathological signs. ECG showed a sinus rhythm at 60 bpm, abnormal repolarization with U waves. Blood gas analysis demonstrated metabolic alkalosis. Complete blood count and biochemistry exams were in range. Potassium iv correction was set up, while angiotensin receptor blocker was discontinued for diagnostic purposes. Echocardiogram evidenced left ventricular concentric hypertrophy with diastolic dysfunction. Diagnostic work-up continued with renal ultrasound and laboratory endocrine screening, with the evidence of increased aldosterone values at rest and after saline infusion test. CT abdomen confirmed the presence of an adrenal adenoma. The patient underwent adrenectomy, with resolution of symptoms.
Conclusions: Primary hyperaldosteronism represents the most frequent cause of secondary endocrine-based hypertension. It is characterized by an aldosterone/plasma renin activity ratio >30 and is generally associated with hypokalemia and metabolic alkalosis. Aldosterone-secreting adrenal adenoma (Conn’s syndrome) provides for surgical treatment.