Resistant hypertension in an aged woman presenting with clinical features simulating ectopic ACTH syndrome--response to spironolactone--.
A 91-year-old depressed woman had resistant hypertension despite a triple combination of anti-hypertensives, including a Ca-antagonist, an angiotensin receptor blocker, and a thiazide diuretic at optimal doses. She had hypokalemic metabolic alkalosis, elevated plasma cortisol and ACTH, and elevated urinary cortisol. The high-dose dexamethasone did not suppress the elevated ACTH and cortisol. The addition of spironolactone to her previous medications controlled and normalized hypertension, hypokalemia, and hormonal abnormalities within 4 months. Her blood pressure, serum electrolytes, and the hormonal states remained normalized for more than a year thereafter. Her depressed mental state also improved after spironolactone.
Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute.
Eisaku
E
Harada
Hirofumi
H
Yasue
Yuji
Y
Mizuno
Yoshinobu
Y
Morikawa
Hitoshi
H
Nakagawa
Fumie
F
Semba
Michihiro
M
Yoshimura
Yoshihiko
Y
Saito
D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000502:physiology*; D000182:ACTH Syndrome, Ectopic / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003480:Cushing Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D003907:Dexamethasone; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D007008:Hypokalemia / Q000209:etiology / Q000503:physiopathology; D011965:Receptors, Glucocorticoid / Q000502:physiology*; D018161:Receptors, Mineralocorticoid / Q000502:physiology*; D013148:Spironolactone / Q000627:therapeutic use*; D013315:Stress, Psychological / Q000150:complications
D000959:Antihypertensive Agents; D011965:Receptors, Glucocorticoid; D018161:Receptors, Mineralocorticoid; D013148:Spironolactone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D006854:Hydrocortisone