A Case of Persistent Hyperkalemia After Unilateral Adrenalectomy for Aldosterone-Producing Adenoma

Abstract

편측 부신 선종에 대한 부신절제술을 시행하는 경우 대다수 환자에서 저칼륨혈증 및 혈중 레닌 활성도, 알도스테론 수치는 정상화되는 것으로 알려져 있으나 저자들은 알도스테론 분비 부신 선종에 대한 편측 부신절제술을 시행한 환자에서 저레닌성 저알도스테론증에 의한 고칼륨혈증 1예를 경험하였다. 단기간에 회복된 기존의 통상적인 보고들에 비해 본 증례에서는 레닌-알도스테론 축의 억제 기간이 길고 고칼륨혈증이 오래 지속되는 임상 경과가 관찰되어 문헌 고찰과 함께 보고하는 바이다.

Primary aldosteronism is a syndrome characterized by various clinical features that are due to excessive autonomous aldosterone secretion not sustained by the activation of the renin-angiotensin system. Aldosterone-producing adrenal adenoma is found in approximately 35% of the patients who suffer with primary aldosteronism. Laparoscopic adrenalectomy is the standard treatment for aldosterone-producing adrenal adenoma, and the result of this operation is normalization of the serum potassium and plasma aldosterone concentrations, as well as correcting the plasma renin activity in most cases. However, it is known that some of the patients with aldosterone-producing adrenal adenoma show transient hyperkalemia postoperatively due to the reversible suppression of the renin-aldosterone axis. We recently experienced the case of a 54-year-old woman with an aldosterone-producing adrenal adenoma, and she presented with severe hyperkalemia after unilateral adrenalectomy. Compared with the previously reported cases that showed transient suppression of the rennin-aldosterone axis for less than 7 months, our patient revealed a prolonged episode of hyperkalemia for 8 months postoperatively, and this required continuous mineralocorticoid replacement.