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Suh, Koh, Park, Hong, Chon, Oh, Woo, Kim, Kim, and Kim: A Case Of Transient Hyporeninemic Hypoaldosteronism After Unilateral Adrenalrectomy for Aldosterone-Producing Adenoma
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2005; 20(5): 502-506.

Published online: 20 October 2005

DOI: https://doi.org/10.3803/jkes.2005.20.5.502

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

Jungho Suh1, Gwanpyo Koh3, Keun-Yong Park3, Jongwook Hong1, Suk Chon1, Seungjoon Oh1, 2, Jeong-taek Woo1, 2, Sung-Woon Kim1, Jin-Woo Kim1, 2, Young-Seol Kim1

1Department of Internal Medicine, Kyung Hee university College of Medicine, Seoul, Korea.

2Research Institute of Endocrinology, Kyung Hee university College of Medicine, Seoul, Korea.

3Department of Endocrinology, College of Medicine, Konyang University, Daejeon, Korea.

Received 8 August 2005       Accepted 23 August 2005

Copyright © 2005 Korean Endocrine Society

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.

Keywords: Aldosterone-producing adenoma, Adrenalectomy, Hypoaldosteronism

Figures and Tables

Fig. 1
EKG finding showing hypokalkemic U-wave (The black arrows in V2, V3).
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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.
jkse-20-502-g002
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.
jkse-20-502-g003
Fig. 3-B
Microscopic finding of adrenal adenoma which shows lipid-abundant clear cells and giant cells.
jkse-20-502-g004
Table 1
Results of Lasix stimulation tests before and after operation in the patient.
jkse-20-502-i001

Reference values are indicated in parentheses. PRA: plasma rennin activity

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