title: A Late Diagnosis of Primary Aldosteronism.
abstract: We report the case of a 41-year-old male patient with juvenile onset refractory hypertension while taking four drugs including a diuretic. Fourteen years before he underwent a complete investigation for secondary hypertension (including the aldosterone to renin ratio-ARR) that was negative. Since that, hypertension control gradually worsened, hypertensive organ damage aggravated and hypokalemia developed in spite of ACE inhibitor treatment. At the re-evaluation ARR was elevated, and the further workup for primary aldosteronism demonstrated an unilateral aldosterone producing adenoma that was surgically removed, with subsequent optimal blood pressure control with two anti-hypertensive drugs. In this case, the failure of the first screening prevented a correct diagnosis of primary aldosteronism, with consequent inadequate blood pressure control in following years and end organ damage. The case suggests the need of clinical follow-up and eventual reappraisal of patients showing a condition of refractory hypertension associated with hypokalemia despite a first negative screening test.
authors.affiliation: Department of Medicine, School of Medicine, University of Verona, Policlinico "G.B. Rossi", P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zorzi
authors.affiliation: Department of Medicine, School of Medicine, University of Verona, Policlinico "G.B. Rossi", P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Olivieri
authors.affiliation: Department of Surgery and Oncology, School of Medicine, University of Verona, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Brazzarola
authors.affiliation: Department of Medicine, School of Medicine, University of Verona, Policlinico "G.B. Rossi", P.le L.A. Scuro 10, 37134, Verona, Italy. francesca.pizzolo@univr.it.
authors.forename: Francesca
authors.identifier: http://orcid.org/0000-0003-4419-3994
authors.initials: F
authors.lastname: Pizzolo
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D057210:Delayed Diagnosis; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D014408:Biomarkers, Tumor; D000450:Aldosterone
keywords: Aldosterone to renin ratio; Primary aldosteronism; Resistant hypertension