title: Unmasked renal impairment and prolonged hyperkalemia after unilateral adrenalectomy for primary aldosteronism coexisting with primary hyperparathyroidism: report of a case.
abstract: We herein report the case of a patient with critical hyperkalemia after unilateral adrenalectomy (ADX) for aldosterone-producing adenomas, which were coexisting with primary hyperparathyroidism. A right adrenal tumor oversecreting mineral corticoid was identified in a 62-year-old female whose kidney function had been impaired due to primary hyperaldosteronism and hyperparathyroidism. The ADX improved her hypertension with normalization of the plasma aldosterone concentration, but without adequately increasing her plasma renin activity. Her eGFR further decreased postoperatively, hyperkalemia appeared and the serum potassium level rose to 6.3 mEq/L at 3 months after ADX. Then, treatment with calcium polystyrene sulfonate jelly was started. Eight months after ADX, a left lower parathyroidectomy was performed, and the serum calcium and intact parathyroid hormone levels decreased to the normal range. The hyperkalemia was difficult to control within 20 months postoperatively without treatment with calcium polystyrene sulfonate jelly or hydrocortisone. This suggests that unmasking the renal impairment and relative hypoaldosteronism after ADX might induce critical hyperkalemia.
authors.affiliation: Department of Endocrine Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan, hibichan@fujita-hu.ac.jp.
authors.forename: Yatsuka
authors.initials: Y
authors.lastname: Hibi
authors.forename: Nobuki
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Midori
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Kimio
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shibata
authors.forename: Chikara
authors.initials: C
authors.lastname: Kagawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Itoh
authors.forename: Katsumi
authors.initials: K
authors.lastname: Iwase
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000601:surgery*; D000315:Adrenalectomy; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology* / Q000601:surgery*; D006947:Hyperkalemia / Q000209:etiology*; D006961:Hyperparathyroidism / Q000150:complications*; D006994:Hypoaldosteronism / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D051437:Renal Insufficiency / Q000209:etiology*