J Korean Endocr Soc.  2009 Sep;24(3):201-205. 10.3803/jkes.2009.24.3.201.

A Case of Persistent Hyperkalemia After Unilateral Adrenalectomy for Aldosterone-Producing Adenoma

Affiliations
  • 1Department of Endocrinology and Metabolism, Ajou University School of Medicine, Korea.
  • 2Department of Pathology, Ajou University School of Medicine, Korea.

Abstract

Primary aldosteronism is a syndrome characterized by various clinical features that are due to excessive autonomous aldosterone secretion not sustained by the activation of the renin-angiotensin system. Aldosterone-producing adrenal adenoma is found in approximately 35% of the patients who suffer with primary aldosteronism. Laparoscopic adrenalectomy is the standard treatment for aldosterone-producing adrenal adenoma, and the result of this operation is normalization of the serum potassium and plasma aldosterone concentrations, as well as correcting the plasma renin activity in most cases. However, it is known that some of the patients with aldosterone-producing adrenal adenoma show transient hyperkalemia postoperatively due to the reversible suppression of the renin-aldosterone axis. We recently experienced the case of a 54-year-old woman with an aldosterone-producing adrenal adenoma, and she presented with severe hyperkalemia after unilateral adrenalectomy. Compared with the previously reported cases that showed transient suppression of the rennin-aldosterone axis for less than 7 months, our patient revealed a prolonged episode of hyperkalemia for 8 months postoperatively, and this required continuous mineralocorticoid replacement.

Keyword

aldosterone-producing adenoma; hyporeninemic hypoaldosteronism; postoperative hyperkalemia

MeSH Terms

Adenoma
Adrenalectomy
Aldosterone
Axis, Cervical Vertebra
Female
Humans
Hyperaldosteronism
Hyperkalemia
Hypoaldosteronism
Middle Aged
Plasma
Potassium
Renin
Renin-Angiotensin System
Aldosterone
Potassium
Renin

Figure

  • Fig. 1 Pre-enhanced (A), early-enhanced (B) and delayed-enhanced (C) computed tomographic images of the abdomen. A low density nodular lesion (black arrows) of 1.3 cm diameter is noted on the right adrenal gland. The nodule shows 17 HU on a pre-enhanced scan, 148 HU on an early enhanced scan and 50 HU on a delayed scan with a washout rate of 66%.

  • Fig. 2 Gross findings of the surgical specimen. The enlarged globular adrenal gland is seen in fat tissue which measures 1.5 × 1.5 × 1.5 cm. The cut section shows a solitary dark-yellow, oval mass with focal myxoid changes.

  • Fig. 3 Histopathologic examination of the adrenal adenoma (H&E stain, ×400). The lesion is composed of lipid-laden mature cortical cells with some nuclear atypia. The tumor cells do not express chromogranin A and S-100 protein by immunohistochemical staining.


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