Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos

Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication t...

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Autores principales:	Germain A,Alfredo M, Kottman G,Cristián, Valdés S,Gloria
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2002
Materias:	Aldosterone Aldosterone antagonists Hyperaldosteronism Renin-angiotensin system
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002001200010
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spelling	oai:scielo:S0034-988720020012000102003-02-05Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicosGermain A,Alfredo MKottman G,CristiánValdés S,Gloria Aldosterone Aldosterone antagonists Hyperaldosteronism Renin-angiotensin system Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required iv hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism (Rev Méd Chile 2002; 130: 1399-1405)info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.130 n.12 20022002-12-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002001200010es10.4067/S0034-98872002001200010
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Aldosterone Aldosterone antagonists Hyperaldosteronism Renin-angiotensin system
spellingShingle	Aldosterone Aldosterone antagonists Hyperaldosteronism Renin-angiotensin system Germain A,Alfredo M Kottman G,Cristián Valdés S,Gloria Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
description	Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required iv hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism (Rev Méd Chile 2002; 130: 1399-1405)
author	Germain A,Alfredo M Kottman G,Cristián Valdés S,Gloria
author_facet	Germain A,Alfredo M Kottman G,Cristián Valdés S,Gloria
author_sort	Germain A,Alfredo M
title	Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
title_short	Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
title_full	Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
title_fullStr	Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
title_full_unstemmed	Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos
title_sort	hiperaldosteronismo primario y embarazo: lecciones obtenidas de 2 casos clínicos
publisher	Sociedad Médica de Santiago
publishDate	2002
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002001200010
work_keys_str_mv	AT germainaalfredom hiperaldosteronismoprimarioyembarazoleccionesobtenidasde2casosclinicos AT kottmangcristian hiperaldosteronismoprimarioyembarazoleccionesobtenidasde2casosclinicos AT valdessgloria hiperaldosteronismoprimarioyembarazoleccionesobtenidasde2casosclinicos
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Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos

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