Primary Aldosteronism Masquerading as Pregnancy-Induced Hypertension ; A Case-based Review

Primary aldosteronism (PA) encompasses a heterogenous group of disorders which is characterized by autonomous excessive aldosterone production resulting in low-renin hypertension. Rarely, PA might manifest as gestational hypertension for the first time because pregnancy related hormonal changes could unmask pre-existing subclinical PA. The data are sparse on prevalence, diagnosis and management of PA during pregnancy. We present a case of a 31-year-old previously normotensive woman who was diagnosed with gestational hypertension at 27th week of her second pregnancy with persistent hypokalaemia and metabolic alkalosis. She underwent emergency lower segment Caesarean section at 36th week of gestation due to inadequate control of blood pressure (BP). Her endocrine workup revealed an elevated plasma aldosterone concentration (PAC) and suppressed plasma renin concentration (PRC). The PAC to PRC ratio was markedly elevated, which is highly suggestive of primary aldosteronism and supports the diagnosis. Adrenal imaging with contrast enhanced computed tomography (CECT) revealed a right adrenal adenoma. So, at eighth week of postpartum, right side laparoscopic adrenalectomy was performed. Her potassium level normalised within a week and she became normotensive in three months. So, we suggest that PA must be considered even in gestational hypertension cases with atypical features.