Hiperaldosteronismo primario y embarazo: lecciones obtenidas de 2 casos clínicos / Primary aldosteronism and pregnancy: report of 2 cases
Rev. méd. Chile
;
130(12): 1399-1405, dic. 2002.
Article
in Spanish
| LILACS
| ID: lil-356132
RESUMO
Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required i.v. hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Pregnancy Complications
/
Hyperaldosteronism
Type of study:
Diagnostic study
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Language:
Spanish
Journal:
Rev. méd. Chile
Journal subject:
Medicine
Year:
2002
Type:
Article
Affiliation country:
Chile
Institution/Affiliation country:
Pontificia Universidad Católica/CL
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