Non-sequential and non-stimulated bilateral adrenal vein sampling utility in primary aldosteronism: Case inform

Abstract

Purpose: To present a case of a 20-year-old Mexican woman with resistant high blood pressure and the procedures the medical staff underwent to identify the etiology of her illness, as well as the choice of treatment. Material and methods: We present a case of a 20-year-old Mexican woman, who showed up to the emergency department at the Military Central Hospital of SEDENA, with decreased visual acuity, persistent headache, and high blood pressure. Her vital signs were a blood pressure of 220/120 mmHg, heart rate of 73 beats per minute, and a respiratory rate of 16 breaths per minute. An electrocardiogram was made and showed hypertrophy of the left cavities. The medical staff sent complementary studies that consisted of a renal ultrasound that showed a right and left kidney with regular dimensions and no signs of stenosis in both renal arteries. The hormonal reports of plasma renin activity were 1.06 ng/ml/h and plasma aldosterone concentration of 30 ng/dL. Plasma aldosterone/renin ratio (ARR) of 28.3 suggested a case of primary aldosteronism (PA). Results: A simple and contrasted computed tomography of the adrenal glands was performed, which reported normal adrenal glands, without identifying focal lesions. Therefore, it was indicated an adrenal catheterization procedure using a non-sequential and non-stimulating technique to expose unilateral primary aldosteronism. Conclusions: Unilateral adrenalectomy is the cure or means of improvement of the clinical signs and symptoms of patients with unilateral primary aldosteronism, we suggest every PA should undergo an adrenal vein sampling seeking lateralization even thought a CT scan shows no evidence of lesions in the adrenal glands. Further investigation of the effects of medical or surgical treatment on the quality of life of Mexican patients with PA is needed. Keywords: Secondary hypertension, Primary aldosteronism, Plasma aldosterone/renin ratio, Adrenal vein sampling, Lateralization index