Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos

• Alfredo M Germain A ^[1] ; Cristián Kottman G ^[2] ; Gloria Valdés S ^[3]
  1. [1] Pontificia Universidad Católica Facultad de Medicina Nefrología
  2. [2] Hospital Parroquial de San Bernardo Servicio de Obstetricia,
  3. [3] Pontificia Universidad Católica Facultad de Medicina Obstetricia/Ginecología

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• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 130, Nº. 12, 2002, págs. 1399-1405
• Idioma: español
• Títulos paralelos:
  • Primary aldosteronism and pregnancy: Report of two cases
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• Resumen

  • Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required iv hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism (Rev Méd Chile 2002; 130: 1399-1405)