Unmasked renal impairment and prolonged hyperkalemia after unilateral adrenalectomy for primary aldosteronism coexisting with primary hyperparathyroidism: report of a case

Yatsuka Hibi, Nobuki Hayakawa, Midori Hasegawa, Kimio Ogawa, Yoshimi Shimizu, Masahiro Shibata, Chikara Kagawa, Yutaka Mizuno, Yukio Yuzawa, Mitsuyasu Itoh, Katsumi Iwase

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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.

Original languageEnglish
Pages (from-to)241-246
Number of pages6
JournalSurgery Today
Volume45
Issue number2
DOIs
Publication statusPublished - 01-01-2015

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All Science Journal Classification (ASJC) codes

  • Surgery

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