P46 | Primary aldosteronism: a rare yet critical contributor to severe gestational hypertension. A case report

Premises: Gestational hypertension and preeclampsia, affecting 6-8% of pregnancies, typically resolve postpartum. However, persistent hypertension after delivery poses a unique challenge. Description: This case report focuses on a 35-year-old woman with a one-year history of hypertension, initially exhibiting normal aldosterone/renin ratio. During pregnancy, she received alpha-methyldopa with limited effectiveness. Emergency cesarean section at 36 weeks was necessitated by uncontrolled hypertension. Postpartum, the patient experienced headaches and muscle cramps, with a mean ABPM24h of 140/100 mmHg on nifedipine and alpha-methyldopa. Further evaluation revealed elevated plasma aldosterone (31.7 ng/dl), suppressed renin (0.9 IUI/ml), an elevated aldosterone-to-renin ratio (35.22), and low serum potassium (2.4 mEq/l). Adrenal imaging identified a 1 cm left adrenal nodule suggestive of adenoma. Effective blood pressure and potassium control were achieved with spironolactone, and the patient is slated for adrenal venous sampling to subtype primary aldosteronism (PA).Conclusions: PA, a significant cause of secondary hypertension, affects less than 1% of pregnant women, often resulting from idiopathic bilateral adrenal hyperplasia or aldosterone-producing adenoma. This case underscores the rarity of PA in pregnancy, with fewer than 40 cases reported in the literature. Given the pivotal role of the renin–angiotensin–aldosterone system in maternal and fetal well-being during pregnancy, early PA diagnosis is imperative to mitigate severe complications associated with gestosis.