Primary aldosteronism and pregnancy

Abstract

The article is devoted to a review of scientific publications that study primary aldosteronism (PA), as well as its features during pregnancy. PA is the most common cause of secondary hypertension. There are few data on PA during pregnancy. PA is characterized by excessive production of aldosterone, which leads to hemodynamic changes in the body, especially the appearance of hypertension. Studies in recent years have shown that up to 88% of adenomas may have gene mutations involved in the regulation of aldosterone synthesis: KCNJ5, CACNA1D, ATP1A1, ATP2B3 and CTNNB1. PA is a renin-independent hypersecretion of aldosterone, which remains an underdiagnosed cause of hypertension. Early diagnosis and treatment contribute to the favorable course of this disease.Changes in renin-angiotensin-aldosterone activity during pregnancy may delay diagnosis. The risk of combined preeclampsia in patients diagnosed with PA may be even higher than in women with chronic primary hypertension with an estimated risk of approximately 17–25%. Given the lack of treatment standards, the management of pregnancies described in scientific publications is different.However, given current knowledge, the following recommendations are possible:• pregnancy should be programmed, and PA should be monitored as much as possible without the use of spironolactone before pregnancy;• adrenalectomy should be performed if unilateral adrenal damage is found before pregnancy;• antihypertensive drugs approved for use during pregnancy, such as methyldopa, β-blockers, should be used during pregnancy planning;• spironolactone should be discontinued before conception.It can be used a diuretic that was prescribed before pregnancy, or prescribed the diuretic in a situation of uncontrolled hypertension.The article also presents our own clinical case of three pregnancies in one woman with PA, their course and outcome. Only the first pregnancy was complicated by preeclampsia, and PA was diagnosed 5 years after the first birth. All pregnancies ended with the birth of living, full-term babies.