6647 Primary Aldosteronism Diagnosed In Pregnancy. Case Report And Review Of The Literature

Abstract

Disclosure: C. De Herdt: None. K. Clotman: None. D. Ysebaert: None. Y. Jacquemyn: None. C. De Block: None.

Background: Primary aldosteronism (PA) is the most common etiology of secondary hypertension in the nonpregnant population but is only sporadically (< 80 case reports) reported in pregnancy. We present a case of PA diagnosed during pregnancy and performed a review of the literature concerning the clinical characteristics, treatment and outcome of women diagnosed with PA during pregnancy. Methods: A structured search was conducted combining terms of PA and pregnancy. Articles in English published between 1991-2023 describing PA diagnosed during pregnancy were included. Diagnostic criteria for PA during pregnancy were: hypertension AND increased aldosterone level AND suppressed renin level or normal renin level in the presence of hypokalemia. Case reports concerning PA diagnosed prior to pregnancy were excluded. Results: Twelve articles were included. With the inclusion of our case report a total of 13 cases with a mean age of 29 ± 5 years are described. Three cases had hypertension prior to pregnancy. All cases had hypokalemia and the majority (8/13) had proteinuria. Eight cases had a suppressed renin level and saline perfusion test was performed in 3 cases. In 11 cases diagnosis of PA was suspected in the second trimester. MRI was performed in 9 cases of which all showed a unilateral adrenal nodule. Three cases were treated with eplerenone in association with safe antihypertensives at a dose of 100-200 mg per day, which resulted in improvement of potassium level but did not result in normotension. Five cases underwent unilateral adrenalectomy as a first line treatment in the second trimester and 2 cases as second line treatment after failure of eplerenone, resulting in normalization of potassium level but no normotension in all except for 1 case. Nine cases had a caesarean section and the median gestational age at delivery was 34 weeks. Three out of 13 newborns deceased (1 case was treated with safe antihypertensives and 2 cases underwent adrenalectomy). Conclusion: PA is a very rare etiology of secondary hypertension during pregnancy. Due to the physiological changes during pregnancy with an increase of all the components of the renin angiotensin aldosterone system, diagnosis of PA is difficult. Saline perfusion test is not recommended. Suggestive features are hypertension before 20 weeks of gestation, worsening of hypertension as pregnancy progresses and hypokalemia. Suppressed renin levels may direct to the diagnosis of PA, but are not mandatory. MRI is the preferred imaging method but only indicated if blood pressure is not well controlled during pregnancy. There are no guidelines for the treatment of PA during pregnancy. The benefit of adrenalectomy is unclear and evidence supporting the choice of medical treatment with eplerenone is anecdotal. This review revealed a poor outcome as despite treatment, blood pressure was only controlled in 3 (/13) cases and the death of 3 (/13) newborns.

Presentation: 6/1/2024