A CASE OF A NEWLY DIAGNOSED PRIMARY ALDOSTERONISM IN A PATIENT WITH PREVIOUSLY THOROUGHLY INVESTIGATED RESISTANT HYPERTENSION

Objective: Primary aldosteronism is the most common form of endocrine hypertension, accounting for approximately 5-20% of all cases. A young, obese female patient was first evaluated in 2014 for resistant hypertension, but her duration of hypertension was 13 year at that time. She had a dry cough taking perindopril. Design and method: No secondary cause was identified apart from obesity, BMI was 36.65 kg/m2. Plasma K was normal (4.0 mmol/L) with 1.5 mg/day indapamide. The diurnal index with 24h-ABPM was 11/14%. We changed her therapy, and with telmisartan 40 bid, amlodipine 2.5 mg morning and 5 mg evening, indapamide SR 1.5 mg morning, doxazosine 4 mg evening and bisoprolol 5 mg morning her BP get into the 110-120/70 mmHg range by the week 8 after the modification. She stopped caughing. In 2023, her BP increased again, on 24h-ABPM the diurnal index changed to 7/10% and new onset hypokalemia developed with the same 1.5 mg indapamide. This time her serum aldosterone concentration increased (59.26 ng/dl), and her BP significantly improved with 25 mg/day spironolactone. That’s why we asked a CT what revealed a right 16 mm adrenal adenoma. Results: In the summer of 2024, a successful laparoscopic adrenalectomy was performed, after which her BP got into the target range only with an amlodipine 5 mg/day monotherapy. Conclusions: Based on the literature data and the size of the removed adenoma, the adenoma was not present nine years earlier - relative to 2023 -, consistent with the examination results at that time. Our case has two key messages. A, Even if the patient is the same with the same resistant hypertension, if the circumstances change, the possible underlying secondary causes must be re-evaluated again. B, In cases of suspected primary aldosteronism, simple screening tests can and should be performed even while maintaining the current therapy!