Key result
Adenoma resection and spironolactone resolve hypertension and hypokalemia in primary aldosteronism despite initially negative ARR.
Why the study?
The aldosterone-to-renin ratio (ARR) is the most reliable screening method for primary aldosteronism but is influenced by many factors, meaning primary aldosteronism cannot be easily excluded by a negative ARR.
Case Report (n=1)
Primary aldosteronism should not be excluded solely based on a negative aldosterone-to-renin ratio in patients with resistant hypertension and hypokalaemia.
Negative aldosterone-to-renin ratio should not exclude primary aldosteronism in resistant hypertension with hypokalaemia; leaves open need for prospective validation of screening thresholds.
BACKGROUND: Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR. CASE PRESENTATION: We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected. CONCLUSION: When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.
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Liu et al. (2021) conducted a case report in Primary aldosteronism (n=1). Unilateral adenoma resection and spironolactone was evaluated on Blood pressure control and hypokalaemia correction. Unilateral adenoma resection and spironolactone successfully controlled blood pressure and corrected hypokalaemia in a patient with primary aldosteronism who initially presented with a negative aldosterone-to-renin ratio.
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