(step2CK)Primary aldosteronism case 진단하기 운영자 / 2005-09-16 11:28:52
A 57-year-old man with a past medical history significant for hypertension and presented for evaluation of chronic hypokalemia. Initially, the low potassium levels were attributed to his antihypertensive medication. However, hypokalemia persisted despite discontinuation of all potassium wasting diuretics and supplementation with 80 mEq of oral potassium daily. A metabolic workup showed a plasma potassium level of 2.7 mEq/L (reference range, 3.3-4.7 mEq/L) and a plasma aldosterone level of 47 ng/dL (reference range, 4-31 ng/dL) (1.30 nmol/L; reference range, 0.11-0.86 nmol/L). The plasma renin activity was decreased, with a plasma aldosterone-plasma renin activity ratio of 47. The sodium level was mildly elevated at 148 mEq/L (reference range, 137-145 mEq/L). The magnesium, chloride, and bicarbonate levels, pH, white blood cell count, and cortisol levels were all within the reference ranges.
Which is the most likely diagnosis?
Primary Hyperaldosteronism
Most common Cause
Primary Hyperaldosteronism (Conn's Disease)
A.Solitary adrenal adenomas (80-90%)
B.Bilateral adrenal hyperplasia (10-20%)
Important feature
usually asymptomatic
Hypertension with hypokalemia
Frontal Headache
Muscle Weakness to flaccid paralysis (Hypokalemia)
Polyuria and Polydipsia (carbohydrate intolerance)
Serum Potassium decreased (Hypokalemia)
Serum Sodium increased (Mild)
Aldosterone to PRA ratio over 20-25 Definately significant if ratio >100
Aldosterone high and plasma renin low
