Polimiopatia hipocalêmica e hipertensão secundária a hiperaldosteronismo primário felino / Hypokalemic polymyopathy and secondary hypertension to feline primary hyperaldosteronism

O hiperaldosteronismo se define pela hipersecreção de aldosterona pelas suprarrenais, resultando em excesso de sódio e redução de potássio sanguíneo. Esta hipersecreção deve-se à síntese autônoma de aldosterona por células adrenais hiperplásicas ou neoplásicas, que agem independentemente da estimulação pelo sistema renina-angiotensina. A doença acomete felinos de adultos maduros a idosos. O excesso de aldosterona culmina em hipertensão sistêmica e/ou hipocalemia, que levam à fraqueza muscular e alterações oculares. O diagnóstico é baseado em exames laboratoriais e de imagem, e o tratamento pode ser clínico ou cirúrgico. O prognóstico é considerado favorável quando as medicações são capazes de melhorar as manifestações clínicas ou quando é possível realizar o procedimento cirúrgico. O presente trabalho visa relatar o caso de um felino macho de 13 anos, castrado, sem raça definida, com hipocalemia persistente secundária a um presuntivo tumor adrenal.

Hyperaldosteronism is defined by the hypersecretion of aldosterone by the adrenal glands resulting in excess sodium and reduced blood potassium. This hypersecretion is due to the autonomous synthesis of aldosterone by hyperplastic or neoplastic adrenal cells, which act independently of stimulation by the renin-angiotensin system. The disease affects felines in the age group from mature adults to the elderly. The excess of aldosterone culminates in systemic hypertension and/or hypokalemia, which leads to muscle weakness and ocular changes. The diagnosis is based on laboratory and imaging tests and treatment can be clinical or surgical. The prognosis is considered favorable when the medications are able to improve the clinical manifestations or when it is possible to perform the surgical procedure. The present paper aims to report the case of a 13-year-old male cat, castrated, crossbred, with persistent hypokalemia secondary to a presumptive adrenal tumor.

Polimiopatia hipocalêmica e hipertensão secundária a hiperaldosteronismo primário felino / Hypokalemic polymyopathy and secondary hypertension to feline primary hyperaldosteronism

O hiperaldosteronismo se define pela hipersecreção de aldosterona pelas suprarrenais, resultando em excesso de sódio e redução de potássio sanguíneo. Esta hipersecreção deve-se à síntese autônoma de aldosterona por células adrenais hiperplásicas ou neoplásicas, que agem independentemente da estimulação pelo sistema renina-angiotensina. A doença acomete felinos de adultos maduros a idosos. O excesso de aldosterona culmina em hipertensão sistêmica e/ou hipocalemia, que levam à fraqueza muscular e alterações oculares. O diagnóstico é baseado em exames laboratoriais e de imagem, e o tratamento pode ser clínico ou cirúrgico. O prognóstico é considerado favorável quando as medicações são capazes de melhorar as manifestações clínicas ou quando é possível realizar o procedimento cirúrgico. O presente trabalho visa relatar o caso de um felino macho de 13 anos, castrado, sem raça definida, com hipocalemia persistente secundária a um presuntivo tumor adrenal.

Hyperaldosteronism is defined by the hypersecretion of aldosterone by the adrenal glands resulting in excess sodium and reduced blood potassium. This hypersecretion is due to the autonomous synthesis of aldosterone by hyperplastic or neoplastic adrenal cells, which act independently of stimulation by the renin-angiotensin system. The disease affects felines in the age group from mature adults to the elderly. The excess of aldosterone culminates in systemic hypertension and/or hypokalemia, which leads to muscle weakness and ocular changes. The diagnosis is based on laboratory and imaging tests and treatment can be clinical or surgical. The prognosis is considered favorable when the medications are able to improve the clinical manifestations or when it is possible to perform the surgical procedure. The present paper aims to report the case of a 13-year-old male cat, castrated, crossbred, with persistent hypokalemia secondary to a presumptive adrenal tumor.

Rabdomiólisis por hipocalemia: manifestación atípica del síndrome de Conn / Rhabdomyolysis due to hypokalemia: an atypical manifestation of Conn's syndrome

Resumen La rabdomiólisis es una afección con espectro de manifestación amplio que puede cursar desde una enfermedad leve asintomática hasta complicaciones mortales por desequilibrio hidroelectrolítico, arritmias o lesión renal aguda. Se comunica el caso de una paciente de 35 años de edad, hipertensa, que ingresó por debilidad muscular posterior a un cuadro gastrointestinal. Tenía hipocalemia severa, elevación de creatincinasa, función renal conservada, hipocalcemia y alcalosis metabólica. Su evaluación integral culminó en el diagnóstico de hiperaldosteronismo primario secundario a un adenoma productor de aldosterona que fue removido de manera quirúrgica sin complicaciones. La manifestación del síndrome de Conn con rabdomiólisis por hipocalemia es excepcional porque la mayoría de los casos se diagnostican con normocalemia o hipocalemia leve a partir del protocolo de hipertensión secundaria. Es necesario un alto nivel de sospecha y evaluación integral para llegar al diagnóstico certero.

Abstract Rhabdomyolysis is a condition with a broad spectrum of presentation that can range from mild asymptomatic disease to fatal complications due to electrolyte imbalance, arrhythmias and/or acute renal injury. We report the case of a 35-year-old woman, hypertensive, who was admitted for muscle weakness following a gastrointestinal condition. Biochemically with severe hypokalemia, elevated creatinekinase, conserved renal function, hypocalcemia and metabolic alkalosis. Their comprehensive evaluation culminated in the diagnosis of primary hyperaldosteronism secondary to an aldosterone-producing adenoma which was surgically removed without complications. The presentation of Conn's syndrome with hypokalemia rhabdomyolysis is exceptional since most cases are diagnosed with normokalemia or mild hypokalemia from the secondary hypertension protocol. A high level of suspicion and integral evaluation are necessary to arrive at the correct diagnosis.

Síndrome de Conn: descripción de dos casos clínicos / Conn`s syndrome: two case reports

El hiperaldosteronismo primario es una de las formaspotencialmente curables de hipertensión arterial. Solía ser considerado un trastorno poco común, pero algunos expertos creen que puede ser la causa de hipertensión en un 5% a un14% de los pacientes. En la mayoría de los casos resulta de un tumor benigno de la glándula suprarrenal y se presenta en personas entre los 30 y 50 años de edad. En estos casos, la HTA es secundaria a la acción de aldosterona a nivel renal, la cual determina un aumento en la reabsorción de sal y agua, lo que se traduce en un aumento del volumen intravascular y secundariamente en elevación de la presión arterial.

Primary hyperaldosteronism is one of the potentially curable forms of arterial hypertension. It used to be considered an uncommon problem, but some experts believe it can be the cause of hypertension in 5 to 14% of patients. In most cases it is a benign tumor of the adrenal glands, appearing between ages 30 and 50 years. In these cases, hypertension is secondary to the action of aldosterone at the renal level, resulting in an increase in the reabsorption of salt and water, which is translated secondarily to an increase in the intravascular volume and an elevation of arterial pressure.

Hiperaldosteronismo primario causa curable de HTA / Primary hyperaldosteronism curable cause of hypertension

Paciente femenina de 48 años, hipertensa, residente en EEUU, presenta en nuestra emergencia con cefalea, palpitaciones, astenia, adinamia y calambes con inicio al viajar en avión a nuestra ciudad su valoración inicial revela TA de 180/97, hipocalemia y alcalosis metabólica. Al sospechar en una causa secundaria de hipertensión arterial (HTA), se realizaron exámenes de imagen en los que se detecta masa tumoral en el polo superior de la glándula suprarrenal izquierda. su manejo inicial clínico fue en base a espironolactona y losartán. Fue intervenida quirúrgicamente realizándose una adrenalectomía izquierda parcial. Posterior a esto se evidencia normalización de las cifras de la tensión arterial y de las consentraciones eléctrolíticas, El estudio histopatológico demostró un adenoma cortical suprarrenal izquierdo de 1,5 cm. El hiperaldosteronismo primario causado por adenoma suprarrenal unilateral es una causa curable de HTA y una vez sospechado, se lo diagnóstica en base a la realización de cuantificaciones de aldosterona sérica (AS), actividad de renina plasmática (ARP), y la relación AS/ARP, que es más sensible y temprana que la alteración del potasio sérico. luego se realiza la localización por imagen. El aspecto multidisciplinario del anejo es clave para lograr éxito en la cura de los pacientes con hiperaldosteronismo.

A 48-year-old female patient, hypertensive, resident in the United States, presented in our emergency with headache, palpitations, asthenia, adynamia and calambes with onset when traveling by plane to our city, her initial evaluation revealed a TA of 180/97, hypokalemia, and metabolic alkalosis. Suspecting a secondary cause of hypertension (HT), imaging tests were performed in which tumor mass was detected in the upper pole of the left adrenal gland. Its initial clinical management was based on spironolactone and losartan. He underwent surgery, performing a partial left adrenalectomy. After this, normalization of the blood pressure and electrolytic consent figures is evident. The histopathological study showed a left adrenal cortical adenoma of 1.5 cm. Primary hyperaldosteronism caused by unilateral adrenal adenoma is a curable cause of hypertension and, once suspected, is diagnosed based on measurements of serum aldosterone (AS), plasma renin activity (ARP), and the AS / ARP ratio. , which is more sensitive and earlier than the alteration of serum potassium. then image localization is performed. The multidisciplinary aspect of the annex is key to achieving success in the cure of patients with hyperaldosteronism.