Usefulness of Alternative Therapy with Hydrocortisone in the Postoperative Management of Severe Primary Aldosteronism

Mineralocorticoid deficiency (MD) with hyperkalemia is an important complication of adrenalectomy in patients with primary aldosteronism (PA). We herein report a 52-year-old man with refractory hypertension, hypokalemia, and severe renal dysfunction due to PA caused by a right adrenal adenoma. His e...

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Bibliographic Details
Published in:Internal Medicine 2023/10/15, Vol.62(20), pp.2981-2988
Main Authors: Asakawa, Masahiro, Takagi, Noriko, Hamada, Daisuke, Yamasaki, Yuko, Takaku, Yutaro, Kawada, Masahiro, Murata, Taro, Katsuta, Hidenori
Format: Article
Language:English
Subjects:
Adrenalectomy
Case Report
Epidermal growth factor receptors
Glomerular filtration rate
Hydrocortisone
Hyperkalemia
Hypertension
Hypokalemia
impaired renal function
Internal medicine
mineralocorticoid deficiency
primary aldosteronism
Renal function
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Summary:Mineralocorticoid deficiency (MD) with hyperkalemia is an important complication of adrenalectomy in patients with primary aldosteronism (PA). We herein report a 52-year-old man with refractory hypertension, hypokalemia, and severe renal dysfunction due to PA caused by a right adrenal adenoma. His estimated glomerular filtration rate (eGFR) transiently increased immediately after adrenalectomy but then gradually declined, and he developed hyperkalemia. A postoperative endocrine examination revealed MD. Considering the patient's hypertension and severe renal dysfunction, we administered hydrocortisone instead of fludrocortisone, which improved the hyperkalemia and stopped the decline in the eGFR. Alternative therapy with hydrocortisone may be useful in such patients with MD.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.1279-22