Preeclampsia: A Diagnosis-Nondiagnosis That Is Too Easily Made: The Case of Primary Hyperaldosteronism

Abstract

After decades in which the major medical textbooks reported with slightly different wordings that preeclampsia (PE) in pregnancy is a transitory kidney disease ultimately cured when the mother delivers, we are finally acknowledging that PE is neither always transitory nor systematically cured and that it may be both the herald of future diseases of the kidney and the cardiovascular system and the epiphenomenon of an underlying disease, as the interesting and well-presented case series published here demonstrates [1][2][3]. While the number of systematic reviews, large-population studies, and long-term registry data are multiplying and most of them conclude with a generic statement that future studies, actions, and programs are needed, few if any changes are taking place in real-life clinical practice [4].The result of this dangerous combination of minimalism (PE is a self-healing disorder), lack of interdisciplinary collaboration (the pragmatic obstetrician holding that "nephrologists make things too complicated," while the cultivated nephrologist retorts that "obstetricians oversimplify"), short-sightedness, and common alibis (no time to see all these women after a PE episode, someone else should do it …) is that women who have already had a stressful and occasionally life-threatening episode of PE lose a precious occasion to receive a timely diagnosis of a potentially curable disease.The series reported here is a clear example of how pregnancy is a valuable but often missed occasion for diagnosis of a potentially serious disease: of the 14 patients described, only 3 were diagnosed as having primary hyperaldosteronism within 1 year from the discovery of hypertension, while in 8 the interval was 5 years or more (up to 12 years). Perhaps even more interestingly, hypertension was diagnosed (or first appeared) in preg-

Management and Outcomes of Primary Aldosteronism in Pregnancy: A Systematic Review

“…Unilateral Medically Treated PA Thirty-one women with hypertension presumed to have unilateral PAP based on imaging alone and treated medically were reported thus far (Table 1). In 3, unilaterality of the disease was uncertain, 19,20 leaving 28 cases for this analysis. These women mainly received labetalol or methyldopa or calcium channel blockers.…”

Primary aldosteronism in pregnancy

“…In fact, although hypokalemia is not a sensitive tool for PA screening in the general population [ 17 ], serum potassium levels have found to be low in the majority of described cases of PA during pregnancy [ 13 , 58 ]. However, the anti-mineralcorticoid effect of progesterone and the physiologic pregnancy-related metabolic acidosis may mask hypokalemia in milder phenotypes of PA [ 66 ].

Fig.

…”