Concurrent Primary Aldosteronism and Renal Artery Stenosis: An Overlooked Condition Inducing Resistant Hypertension

Refractory hypokalaemia and hypertension in pregnancy in a woman with renal artery stenosis

Renal artery stenosis is rare in pregnancy. Patients generally present with hypertension and/or pre-eclampsia. Accompanying hypokalaemia is usually mild or absent. Our case demonstrates the unusual finding of severe and refractory hypokalaemia together with hypertension in a woman with renal artery stenosis in pregnancy. The differential diagnosis of hypokalaemia with hypertension in pregnancy is discussed.

Aldosterone-to-Renin Ratio Changes in Patients With Renal Artery Stenosis and Aldosteronism

We conducted a retrospective cohort study to investigate changes in the aldosterone-to-renin ratio (ARR) and other influencing factors in patients with renal artery stenosis (RAS) and primary aldosteronism (PA). Patients with RAS and PA admitted to our hospital between January 2016 and December 2021 were retrospectively selected. Based on the standardized PA screening results, the patients were divided into aldosterone-to-renin ratio-positive and -negative groups. The clinical features of the patients were compared. Binary logistic regression analysis was performed to identify the factors contributing to the comorbidity of RAS with false-negative PA. A total of 78 patients (mean age: 60.2 ± 10.2 years) were selected, among whom 46 (59%) were male. Overall, 69 patients had Stage 3 hypertension (88.5%) and 57 had hypokalemia (73.1%). Additionally, 42 (53.8%) and 36 (46.2%) patients were aldosterone-to-renin ratio-positive and -negative, respectively. The aldosterone-to-renin ratio-positive group showed significant differences in malignant hypertension (2.4% vs. 27.8%; p = 0.002), Stage 3 hypertension (81.0% vs. 97.2%; p = 0.033), and RAS degree (64.3 ± 16.4% vs. 71.8 ± 14.4%; p = 0.032). Malignant hypertension (odds ratio, 15.250; 95% confidence interval, 1.787-130.132; p = 0.013) and RAS degree (odds ratio, 1.034; 95% confidence interval, 1.002-1.068; p = 0.036) influenced the comorbidity of RAS with false-negative PA. Malignant hypertension and severe RAS can contribute to false-negative PA results. Therefore, PA screening test results should be carefully analyzed and rechecked following RAS treatment to confirm the presence of PA.

Concurrent Adrenal Adenoma, Unilateral Adrenal Hyperplasia, and Bilateral Renal Artery Stenosis in a 61-Year-Old Man

We report a case of a very rare association of adrenal adenoma, unilateral adrenal hyperplasia, and bilateral renal artery stenosis. A 61-year-old man with a remarkable history of two severe strokes was admitted to the Nephrology department with hypertension associated with severe hypokalemia and metabolic alkalosis. Doppler of renal arteries was not conclusive, so contrast-enhanced scanning was done revealing a left adrenal adenoma, right adrenal hyperplasia, and bilateral moderate renal artery stenosis. After control of blood pressure with central anti-hypertensive drugs and calcium channel blockers and normalization of kalemia under potassium supplementation, the hormonal analysis was done showing an elevated plasma aldosterone concentration at 1,568 pmol/L, with a direct renin concentration below the detection level. Primary aldosteronism was confirmed and the prescription of an anti-aldosterone agent led to the control of blood pressure and potassium plasmatic levels. In front of arterial hypertension with hypokalemia, we recommend the assessment of secondary and primary hyperaldosteronism in a systematic way since the association of two or even three etiologies of hyperaldosteronism is possible and an appropriate diagnosis is essential for adequate treatment.

Recent progress in unraveling cardiovascular complications associated with primary aldosteronism: a succinct review

This comprehensive review offers a thorough exploration of recent advancements in our understanding of the intricate cardiovascular complications associated with Primary Aldosteronism (PA). PA encompasses a spectrum of conditions characterized by hypertension and excessive production of aldosterone operating independently of the renin-angiotensin system. Given its association with an elevated risk of cardiovascular and cerebrovascular complications, as well as a higher incidence of metabolic syndrome in comparison to individuals with essential hypertension (EH), an accurate diagnosis of PA is of paramount importance. This review delves into the intricate interplay between PA and cardiovascular health and focuses on the key pathophysiological mechanisms contributing to adverse cardiac outcomes. The impact of different treatment modalities on cardiovascular health is also examined, offering insights into potential therapeutic approaches. By highlighting the significance of recognizing PA as a significant contributor to cardiovascular morbidity, this review emphasizes the need for improved screening, early diagnosis, and tailored management strategies to both enhance patient care and mitigate the burden of cardiovascular diseases. The findings presented herein underscore the growing importance of PA in the context of cardiovascular medicine and emphasize the potential for translating these insights into targeted interventions to improve patient outcomes.

Primary Aldosteronism Masked by Accessory Renal Arteries: A Case Report

Primary aldosteronism (PA) is the most frequent form of secondary endocrine hypertension, which is characterized by excessive aldosterone secretion and suppressed renin. The currently recommended diagnostic algorithm is very clear, and the plasma aldosterone-to-renin ratio (ARR) is considered the first-line screening test. However, this indicator is influenced by many factors, some of which may cause false-negative results, consequently leading to underdiagnosed PA. Here, we report the rare case of a 38-year-old man who presented with bilateral accessory renal arteries and aldosterone-producing adenoma but had a negative ARR test result.