J Korean Soc Endocrinol.  2005 Oct;20(5):502-506. 10.3803/jkes.2005.20.5.502.

A Case Of Transient Hyporeninemic Hypoaldosteronism After Unilateral Adrenalrectomy for Aldosterone-Producing Adenoma

• Suh J
• Koh G
• Park KY
• Hong J
• Chon S
• Oh S
• Woo JT
• Kim SW
• Kim JW
• Kim YS

• KMID: 2200598
• DOI: http://doi.org/10.3803/jkes.2005.20.5.502

Abstract

Primary aldosteronism is due to either a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex in most cases. A unilateral adrenalectomy in hypertensive and hypokalemic patients, with a well-documented adrenal adenoma, is usually followed by the correction of hypokalemia in all subjects, with the cure of hypertension in 60 to 87% of patients. Here, a unique case, in which a unilateral adrenalectomy for the removal of an adrenal adenoma was followed by severe hyperkalemia, low levels of plasma renin activity and serum aldosterone, suggestive of chronic suppression of the renin-aldosterone axis, is reported. In a follow-up Lasix stimulation test on the 70th day after surgery, the suppression of the renin-aldosterone axis was resolved, indicating the suppression was transient. Patients undergoing a unilateral adrenalectomy for an aldosterone-producing adenoma should be closely followed up to avoid severe hyperkalemia.

MeSH Terms

Adenoma*
Adrenal Cortex
Adrenalectomy
Aldosterone
Axis, Cervical Vertebra
Follow-Up Studies
Furosemide
Humans
Hyperaldosteronism
Hyperkalemia
Hyperplasia
Hypertension
Hypoaldosteronism*
Hypokalemia
Plasma
Renin
Aldosterone
Furosemide
Renin

Figure

• 

  Fig. 1 EKG finding showing hypokalkemic U-wave (The black arrows in V2, V3).

• 

  Fig. 2 A. Enhanced (A) and Post-enhanced (B) abdominal CT finding showing a right adrenal mass (the black arrow). B. The two CT films shows a moderately enhanced mass on right adrenal gland. Its size is about 1×1 cm and the nature is homogenous.

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  Fig. 3-A Gross finding of adrenal adenoma which is circular shaped and golden yellow colored. The wellmarginated circular mass is about 1cm in diameter and contains much lipid. Around the adenoma there is perirenal fat tissue.

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  Fig. 3-B Microscopic finding of adrenal adenoma which shows lipid-abundant clear cells and giant cells.

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