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Published on: January 24, 2012
Primary hyperaldosteronism causing posttransplantation hypertension: localization by adrenal vein sampling
H I Fahmy1, J C Melby, D E Mesler
1Department of Medicine, Boston Medical Center, MA, USA.
Summary
Primary hyperaldosteronism can cause resistant hypokalemia and hypertension in kidney transplant patients. Adrenal vein sampling is crucial for diagnosing adrenal adenomas when imaging is inconclusive.
Area of Science:
- Nephrology
- Endocrinology
- Transplant Surgery
Background:
- Persistent hypertension and hypokalemia are common post-kidney transplant complications.
- Exclusion of allograft renal artery stenosis, rejection, and cyclosporine toxicity is essential.
Observation:
- A 58-year-old male kidney transplant recipient presented with refractory hypokalemia and hypertension.
- Biochemical analysis indicated primary hyperaldosteronism, but initial MRI showed normal adrenal anatomy.
Findings:
- Adrenal vein sampling successfully lateralized a left adrenal adenoma.
- Surgical removal of the adenoma resolved hypokalemia and improved blood pressure control.
Implications:
- Resistant hypokalemia and post-transplant hypertension warrant investigation for primary hyperaldosteronism.
- Adrenal vein sampling is a valuable tool for diagnosing adrenal pathology when imaging is negative.
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