Abstract

Primary aldosteronism is the most common cause of secondary hypertension; however, the dynamic regulation of aldosterone by potassium is less well studied and current diagnostic recommendations are imprecise. We describe a young man who presented with resistant hypertension and severe hypokalemia. The workup initially revealed undetectable aldosterone despite acute potassium repletion. Chronic potassium supplementation eventually uncovered hyperaldosteronism. In situ genetic studies revealed a gain-of-function KCNJ5 mutation within an aldosterone-producing adenoma that was clinically responsive to changes in extracellular potassium. We highlight a unique presentation of Conn’s syndrome and discuss the implications for the molecular mechanisms of potassium regulation of aldosterone.

Details

Title
Masking by hypokalemia—primary aldosteronism with undetectable aldosterone
Author
Boyle, Rebecca A 1 ; Baker, Jessica E 2 ; Charu, Vivek 3 ; Rainey, William E 2 ; Bhalla, Vivek 4 

 Stanford Hypertension Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford HealthCare, Stanford Hospital, Stanford, CA, USA 
 Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA; Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA 
 Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA 
 Stanford Hypertension Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA 
Pages
1269-1271
Publication year
2021
Publication date
Apr 2021
Publisher
Oxford University Press
ISSN
20488505
e-ISSN
20488513
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3169591120
Copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.