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논문분류	춘계학술대회 초록집
제목	An Interesting Case of Mineralocorticoid Deficiency and Progressive Kidney Insufficiency after Unilateral Adrenalectomy
저자	Hye Jun Lee
출판정보	2024; 2024(1):
키워드
초록	Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, and 30~40% of PA are caused by aldosterone-producing adenoma (APA). Unilateral adrenalectomy (UA) is the main treatment option for APA, however, we should monitor clinical manifestations and related complications that may occur after UA. A 54-year-old female visited with weakness lasted for 3 weeks. She was taking antihypertensive medications including angiotensin receptor blocker. One month ago, she underwent left adrenalectomy for APA identified during evaluation of secondary hypertension. Her BP prior to adrenalectomy was very high, but her BP was well controlled after UA. Laboratory data showed followings: before UA- creatinine, 0.94 mg/dl; potassium, 2.2 mEq/L; plasma renin activity, <0.01 ng/ml/hr; plasma aldosterone, 69.68ng/dL; urine potassium-creatinine ratio, 16.83 mEq/g; 4 weeks after UA- creatinine, 2.73 mg/dl; potassium, 6.0 mEq/L; plasma renin activity, 0.12 ng/ml/hr; plasma aldosterone, 1.49ng/dL; urine potassium-creatinine ratio, 2.01 mEq/g. Hyperkalemia improved after mineralocorticoid supplementation. However, the decrease in GFR remained even after 1 month. We performed the kidney biopsy. The global sclerosis was confirmed in 15 out of 18 glomeruli and foot processes were focally effaced. There was no evidence of immune complex. Her renal function still has not recovered 1 year after UA (serum creatinine, 2.32 mg/dl and serum potassium, 5.2 mEq/L). Hyperaldosteronism may raise the GFR. However, the change can be normalized with appropriate treatment. The incidence of postoperative hyperkalemia and renal insufficiency is also low, but the mechanism remains unclear. However, several factors such as age, duration of hypertension, size of adenoma, lower eGFR and lower potassium may affect hyperkalemia and progressive kidney dysfunction after UA. The prolonged hyperfunctioning APA may result in dysfunction of the contralateral adrenal gland, resulting in hypoaldosteronism. This change can lead to hyperkalemia and progressive kidney insufficiency. Thus, patients after UA should be carefully monitored.
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