Cargando…
Masking by hypokalemia—primary aldosteronism with undetectable aldosterone
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. T...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023175/ https://www.ncbi.nlm.nih.gov/pubmed/33841871 http://dx.doi.org/10.1093/ckj/sfaa150 |
_version_ | 1783675078946324480 |
---|---|
author | Boyle, Rebecca A Baker, Jessica E Charu, Vivek Rainey, William E Bhalla, Vivek |
author_facet | Boyle, Rebecca A Baker, Jessica E Charu, Vivek Rainey, William E Bhalla, Vivek |
author_sort | Boyle, Rebecca A |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8023175 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-80231752021-04-09 Masking by hypokalemia—primary aldosteronism with undetectable aldosterone Boyle, Rebecca A Baker, Jessica E Charu, Vivek Rainey, William E Bhalla, Vivek Clin Kidney J Exceptional Cases 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. Oxford University Press 2020-10-07 /pmc/articles/PMC8023175/ /pubmed/33841871 http://dx.doi.org/10.1093/ckj/sfaa150 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Exceptional Cases Boyle, Rebecca A Baker, Jessica E Charu, Vivek Rainey, William E Bhalla, Vivek Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title | Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title_full | Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title_fullStr | Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title_full_unstemmed | Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title_short | Masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
title_sort | masking by hypokalemia—primary aldosteronism with undetectable aldosterone |
topic | Exceptional Cases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023175/ https://www.ncbi.nlm.nih.gov/pubmed/33841871 http://dx.doi.org/10.1093/ckj/sfaa150 |
work_keys_str_mv | AT boylerebeccaa maskingbyhypokalemiaprimaryaldosteronismwithundetectablealdosterone AT bakerjessicae maskingbyhypokalemiaprimaryaldosteronismwithundetectablealdosterone AT charuvivek maskingbyhypokalemiaprimaryaldosteronismwithundetectablealdosterone AT raineywilliame maskingbyhypokalemiaprimaryaldosteronismwithundetectablealdosterone AT bhallavivek maskingbyhypokalemiaprimaryaldosteronismwithundetectablealdosterone |