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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 376-380. doi: 10.19723/j.issn.1671-167X.2022.02.028

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Persistent and serious hyperkalemia after surgery of primary aldosteronism: A case report

WANG Wei1,CAI Lin2,GAO Ying1,GUO Xiao-hui1,ZHANG Jun-qing1,△()   

  1. 1. Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
    2. Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-05-15 Online:2022-04-18 Published:2022-04-13
  • Contact: Jun-qing ZHANG E-mail:junqing.zhang@pkufh.com

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Abstract:

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with “primary aldosteronism”, “hyperkalemia”, “surgical treatment” was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors’ aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.

Key words: Primary aldosteronism, Surgery, Hyperkalemia

CLC Number: 

  • R589.4

Figure 1

Levels of plasma potassium, eGFR, PAC pre-operation (pre-op) and post-operation (post-op) PAC, plasma aldosterone concentration; eGFR, estimated glomerular filtration rate."

Table 1

Adrenal hormones, kidney function and electrolyte levels pre- and post-operation"

Items Pre-op 1 month
post-op		 3 months
post-op		 7 months
post-op		 9 months
post-op		 14 months
post-op		 Normal range
ACTH/(ng/L) 9.33 - 39.53 33.23 - - 7.2-63.3
Serum cortisol/(μg/dL) 10.06 - 20.82 14.95 - - 6.2-19.4
Renin activity/[ng/(mL·h)] 1.32 - - - - - 0.13-2.5
Renin concentration/(mU/L) - - 9.7 24.8 8.6 21.2 4.4-46.1
Plasma aldosterone/(ng/dL) 35.69 - 2.12 8.47 3.96 11.3 3.0-35.3
ARR - - 0.22 0.34 0.46 0.53 <3.7
Creatinine/(μmol/L) 178.23 257.00 206.00 237.00 223.00 226 44-133
eGFR/[mL/(min·1.73 m2)] 33.92 21.79 28.47 24.04 25.87 25.28 >90
Plasma sodium/(mmol/L) 142.08 137.00 138.00 138.00 139.0 137.0 137-147
Plasma potassium/(mmol/L) 3.61 7.00 4.70 6.70 5.10 6.5 3.5-5.3
Plasma chlorine/(mmol/L) 107.6 109.0 106.0 108.0 104.0 108 99-110
CO2/(mmol/L) 27.45 18.80 20.20 17.50 19.50 15 22-30
24 hour urine potassium/(mmol/24 h) - - 23.1 - 52.8 - 25-125
24 hour urine sodium/(mmol/24 h) - - 304.5 - 283.8 - 130-260

Table 2

Summary of literatures about hyperkalemia after surgery in primary aldosteronism patients"

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[7] Wada N, Shibayama Y, Umakoshi H, et al. Hyperkalemia in both surgically and medically treated patients with primary aldosteronism[J]. J Hum Hypertens, 2017, 31(10):627-632.
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