Diagnosis and Management of Primary Aldosteronism in Pregnancy: Case Report and Review of the Literature

Abstract

Primary aldosteronism rarely complicates pregnancy. We present a woman with primary aldosteronism in pregnancy associated with severe preeclampsia. A 33-year-old Japanese woman with hypertension was referred to our hospital at 25 weeks of gestation. Her blood pressure was 180/100 mmHg, and laboratory tests identified a low serum potassium level and moderate proteinuria on urinalysis. The fetus was diagnosed with growth restriction. Plasma renin activity (PRA) value was 2.2 ng/mL/h and plasma aldosterone concentration (PAC) was elevated (260 pg/mL). The patient was treated medically. At 27 weeks of gestation, we noted persistent late fetal heart rate decelerations associated with uterine contractions. Therefore, elective caesarean section was performed and she was delivered of a 698-g female. After delivery, PRA declined and PAC remained elevated. Abdominal computerized tomography scan and I131-iodochoresterol scan revealed a tumor in the left adrenal gland. Laparoscopic adrenalectomy was performed and confirmed the clinical diagnosis.

Hipertensión arterial en la mujer adulta

“…El descenso se atribuye a la inhibición competitiva de aldosterona por la progesterona placentaria y a la estimulación de los sistemas vasodilatadores en el embarazo 25 . Sin embargo, hay casos de HAP asociados a embarazo en que se agrava la HTA 26 . En la premenopausia, la HTA RV se debe generalmente a una displasia fibromuscular, que puede asociarse a hipercoagulabilidad con riesgo de infartos renales.…”

Eplerenone Use in Primary Aldosteronism During Pregnancy

“…[1][2] Aggressive management is strongly recommended, because the risk of complications in both the mother and the fetus is high. 3 Difficulties arise because of limited therapeutic options attributed to fetal toxicity.…”

“…4 On the other hand, in middle and late pregnancy, primary aldosteronism is best treated medically. 1 Pharmacological options such as spironolactone, the aldosterone-receptor antagonist, which is primarily used in nonpregnant patients, is contraindicated in pregnancy, because it crosses the placenta and has potent antiandrogenic effects that can cause ambiguous genitalia in a male fetus. 5 However, most case reports and letters in the literature report the use of spironolactone in pregnancy.…”

“…5 However, most case reports and letters in the literature report the use of spironolactone in pregnancy. 1 Angiotensin-converting enzyme inhibitors and angiotensin II receptor 1 antagonists are also contraindicated. Although never reported in the literature, we chose to use eplerenone (not commercially available in Italy) based on the fact that the molecule is much more selective than spironolactone on the mineralocorticoid receptor, reducing the risk of antiandrogenic effects.…”

Adrenal Disease and Pregnancy

“…Primary hyperaldosteronism rarely has been reported in pregnancy and is most often caused by an adrenal adenoma (Okawa et al, 2002). There are reports of glucocorticoid remediable hyperaldosteronism in pregnancy (Wyckoff et al, 2000).…”