Abstract

Hypertension is one of the most common cardiovascular diseases during pregnancy. Primary hyperaldosteronism (PHA) is the most frequent endocrinological, secondary cause of hypertension, rarely diagnosed in pregnant women. In the available literature about 50 cases of PHA in pregnant women have been described. PHA is often a cause of resistant hypertension. PHA can cause life-threatening complications both for the pregnant woman and the fetus. Diagnosis of PHA in pregnancy is difficult due to the antagonistic effect of progesterone on aldosterone, physiological increase of aldosterone release during gestation and frequent normokalaemic clinical course. Typical pharmacological treatment of PHA is limited due to the anti‑androgenic effect of spironolactone, lack of data concerning the safety of eplerenone and limited access to amiloride in Poland. Surgical treatment is a therapeutic option only in early pregnancy. This paper presents the current state of knowledge on diagnostic methods and treatment of PHA in pregnant women and a systematic review of cases described in the literature.

References

• 1. Abdelmannan D., Aron D.C.: Adrenal disorders in pregnancy. Endocrinol.Metab. Clin. North Am., 2011; 40: 779-794
  Google Scholar
• 2. Aboud E., De Swiet M., Gordon H.: Primary aldosteronism in pregnancy- should it be treated surgically? Ir. J. Med. Sci., 1995; 164: 279-280
  Google Scholar
• 3. Al-Ali N.A., El-Sandabesee D., Steel S.A., Roland J.M.: Conn’s syndromein pregnancy successfully treated with amiloride. J. Obstet.Gynaecol., 2007; 27: 730-731
  Google Scholar
• 4. Albiger N.M., Sartorato P., Mariniello B., Iacobone M., Finco I.,Fassina A., Mantero F.: A case of primary aldosteronism in pregnancy:do LH and GNRH receptors have a potential role in regulating aldosteronesecretion? Eur. J. Endocrinol., 2011; 164: 405-412
  Google Scholar
• 5. Aloia J.F., Beutow G.: Malignant hypertension with aldosteronomaproducing adenoma. Am. J. Med. Sci., 1974; 268: 241-245
  Google Scholar
• 6. Aoi W., Doi Y., Tasaki S., Mitsuoka T., Suzuki S., Hashiba K.: Primaryaldosteronism aggravated during peripartum period. Jpn. Heart J.,1978; 19: 946-953
  Google Scholar
• 7. Baron F., Sprauve M.E., Huddleston J.F., Fisher A.J.: Diagnosis andsurgical treatment of primary aldosteronism in pregnancy: a casereport. Obstet. Gynecol., 1995; 86: 644-645
  Google Scholar
• 8. Biglieri E.G., Slaton P.E.Jr.: Pregnancy and primary aldosteronism.J. Clin. Endocrinol. Metab., 1967; 27: 1628-1632
  Google Scholar
• 9. Boucher B.J., Mason A.S.: Conn’s syndrome with associated pregnancy.Proc. R. Soc. Med., 1965; 58: 575-576
  Google Scholar
• 10. Cabassi A., Rocco R., Berretta R., Regolisti G., Bacchi-Modena A.:Eplerenone use in primary aldosteronism during pregnancy. Hypertension,2012; 59: e18-e19
  Google Scholar
• 11. Chudek J., Witkowicz J., Kukla M., Piecha G., Zarzecki M., WiencekR., Wystrychowski A., Nieszporek T., Kokot F., Więcek A.: Częstośćwystępowania i charakterystyka zmian morfologicznych nadnerczyocenianych na podstawie tomografii komputerowej u chorychna nadciśnienie tętnicze z podwyższoną wartością współczynnikaaldosteronowo-reninowego. Naciśnienie Tętnicze, 2005; 9: 252-260
  Google Scholar
• 12. Crane M.G., Andes J.P., Harris J.J., Slate W.G.: Primary aldosteronismin pregnancy. Obstet. Gynecol., 1964; 23: 200-208
  Google Scholar
• 13. Elterman J.J., Hagen G.A.: Aldosteronism in pregnancy: associationwith virilization of female offspring. South. Med. J., 1983;76: 514-516
  Google Scholar
• 14. Fikri Benbrahim O., García Agudo R., Cazalla Cadenas F., MartínezCalero A., González-Spínola J.: Diagnosis of secondary hypertensioncausing miscarriage during the first trimester of pregnancy. Nefrologia,2011; 31: 229-231
  Google Scholar
• 15. Fujiyama S., Mori Y., Matsubara H., Okada S., Maruyama K., MasakiH., Yonemoto T., Nagata T., Umeda Y., Matsuda T., Iwasaka T.,Inada M.: Primary aldosteronism with aldosterone-producing adrenaladenoma in a pregnant woman. Intern. Med., 1999; 38: 36-39
  Google Scholar
• 16. Germain A.M., Kottman C., Valdés G.: Primary aldosteronism andpregnancy: report of 2 cases. Rev. Med. Chil., 2002; 130: 1399-1405
  Google Scholar
• 17. Gordon R.D., Fishman L.M., Liddle G.W.: Plasma renin activityand aldosterone secretion in a pregnant woman with primary aldosteronism.J. Clin. Endocrinol. Metab., 1967; 27: 385-388
  Google Scholar
• 18. Grant C.S., Carpenter P., van Heerden J.A., Hamberger B.: Primaryaldosteronism. Clinical management. Arch. Surg., 1984; 119: 585-590
  Google Scholar
• 19. Grossman A., Pacak K., Sawka A., Lenders J.W., Harlander D.,Peaston R.T., Reznek R., Sisson J., Eisenhofer G.: Biochemical diagnosisand localization of pheochromocytoma: can we reach a consensus?Ann. N. Y. Acad. Sci., 2006; 1073: 332-347
  Google Scholar
• 20. Hamilton E., O’Callaghan C., O’Brien R.M., Stowasser M., GordonR., Zajac J., Grossmann M.: Familial hyperaldosteronism type 1in pregnancy. Intern. Med. J., 2009; 39: 135-136
  Google Scholar
• 21. Hammond T.G., Buchanan J.D., Scoggins B.A., Thatcher R., WhitworthJ.A.: Primary hyperaldosteronism in pregnancy. Aust. N.Z. J.Med., 1982; 12: 537-539
  Google Scholar
• 22. Hirata S., Yoshida K., Kinoshita T.: Primary aldosteronism. Horm.Clin., 1987; 15: 275-279
  Google Scholar
• 23. Januszewicz A., Kokot F., Widecka K., Więcek A.: Zalecenia dotyczącediagnostyki i leczenia pierwotnego hiperaldosteronizmu.Nadciśnienie Tętnicze, 2008; 12: 155-168
  Google Scholar
• 24. Kosaka K., Onoda N., Ishikawa T., Iwanaga N., Yamamasu S., TaharaH., Inaba M., Ishimura E., Ogawa Y., Hirakawa K.: Laparoscopicadrenalectomy on a patient with primary aldosteronism duringpregnancy. Endocr. J., 2006; 53: 461-466
  Google Scholar
• 25. Kreze A.Jr., Kothaj P., Dobáková M., Rohon S.: Primary aldosteronismcaused by aldosterone-producing adenoma in pregnancy- complicated by EPH gestosis. Wien. Klin. Wochenschr., 1999; 111:855-857
  Google Scholar
• 26. Krysiak R., Samborek M., Stojko R.: Primary aldosteronism inpregnancy. Acta Clin. Belg., 2012; 67: 130-134
  Google Scholar
• 27. Lenders J.W.: Pheochromocytoma and pregnancy: a deceptiveconnection. Eur. J. Endocrinol., 2012; 166: 143-150
  Google Scholar
• 28. Levy J., Marx G.F.: Problems related to aldosteronism duringcesarean section. Anesthesiology, 1971; 34: 294-297
  Google Scholar
• 29. Lins P.E., Adamson U.: Primary aldosteronism. A follow-up studyof 28 cases of surgically treated aldosterone-producing adenomas.Acta Med. Scand., 1987; 221: 275-282
  Google Scholar
• 30. Lotgering F.K., Derkx F.M., Wallenburg H.C.: Primary hyperaldosteronismin pregnancy. Am. J. Obstet. Gynecol., 1986; 155: 986-988
  Google Scholar
• 31. Lu W., Zheng F., Li H., Ruan L.: Primary aldosteronism and pregnancy:a case report. Aust. N. Z. J. Obstet. Gynaecol., 2009; 49: 558
  Google Scholar
• 32. Mancia G., Fagard R., Narkiewicz K., Redon J., Zanchetti A., BöhmM., Christiaens T., Cifkova R., De Backer G., Dominiczak A., GalderisiM., Grobbee D.E., Jaarsma T., Kirchhof P., Kjeldsen S.E. i wsp.: WytyczneESH/ESC dotyczące postępowania w nadciśnieniu tętniczymw 2013 roku. Kardiol. Pol., 2013; 71 (Suppl. 3): 27-118
  Google Scholar
• 33. Matsumoto J., Miyake H., Isozaki T., Koshino T., Araki T.: Primaryaldosteronism in pregnancy. J. Nippon Med. Sch., 2000; 67: 275-279
  Google Scholar
• 34. Merrill R.H., Dombroski R.A., MacKenna J.M.: Primary hyperaldosteronismduring pregnancy. Am. J. Obstet. Gynecol., 1984; 150: 786-787
  Google Scholar
• 35. Messina M., Biffignandi P., Ghigo E., Jeantet M.G., Molinatti G.M.:Possible contraindication of spironolactone during pregnancy. J.Endocrinol. Invest., 1979; 2: 222
  Google Scholar
• 36. Murakami I., Ishimaru T., Ando K.: Primary aldosteronism duringpregnancy. Bull. Nagoya City Hosp., 1986; 9: 89-93
  Google Scholar
• 37. Murakami T., Watanabe Ogura E., Tanaka Y., Yamamoto M.:High blood pressure lowered by pregnancy. Lancet, 2000; 356: 1980
  Google Scholar
• 38. Neerhof M.G., Shlossman P.A., Poll D.S., Ludomirsky A., WeinerS.: Idiopathic aldosteronism in pregnancy. Obstet. Gynecol., 1991;78: 489-491
  Google Scholar
• 39. Nezu M., Miura Y., Noshiro T., Inoue M.: Primary aldosteronismas a cause of severe postpartum hypertension in two women. Am. J.Obstet. Gynecol., 2000; 182: 745-746
  Google Scholar
• 40. Nursal T.Z., Caliskan K., Ertorer E., Parlakgumus A., Moray G.:Laparoscopic treatment of primary hyperaldosteronism in a pregnantpatient. Can. J. Surg., 2009; 52: E188-E190
  Google Scholar
• 41. Okawa T., Asano K., Hashimoto T., Fujimori K., Yanagida K.,Sato A.: Diagnosis and management of primary aldosteronism inpregnancy: case report and review of the literature. Am. J. Perinatol.,2002; 19: 31-36
  Google Scholar
• 42. Otokida K., Takeda M., Fujiwara T.: A case of primary aldosteronismin pregnancy. Horm. Clin., 1988; 36: 167-171
  Google Scholar
• 43. Ronconi V., Turchi F., Zennaro M.C., Boscaro M., Giacchetti G.:Progesterone increase counteracts aldosterone action in a pregnantwoman with primary aldosteronism. Clin. Endocrinol., 2011;74: 278-279
  Google Scholar
• 44. Saito I., Hasegawa C., Saruta T.: Primary aldosteronism and hypertensionin pregnancy. Horm. Clin., 1992; 40: 493-498
  Google Scholar
• 45. Sakurada Y., Takeda N., Yasuda A.: Primary aldosteronism. Obstet.Gynecol., 1987; 54: 71-74
  Google Scholar
• 46. Shalhav A.L., Landman J., Afane J., Levi R., Clayman R.V.: Laparoscopicadrenalectomy for primary hyperaldosteronism duringpregnancy. J. Laparoendosc. Adv. Surg. Tech. A., 2000; 10: 169-171
  Google Scholar
• 47. Shigematsu K., Nishida N., Sakai H., Igawa T., Suzuki S., KawaiK., Takahara O.: Primary aldosteronism with aldosterone-producingadenoma consisting of pure zona glomerulosa-type cells in a pregnantwoman. Endocr. Pathol., 2009; 20: 66-72
  Google Scholar
• 48. Shimizu A., Aoi W., Akahoshi M., Utsunomiya T., Doi Y., SuzukiS., Kuramochi M., Hashiba K.: Elevation of plasma renin activity duringpregnancy and rupture of a dissecting aortic aneurysm in a patientwith primary aldosteronism. Jpn. Heart J., 1983; 24: 995-1006
  Google Scholar
• 49. Solomon C.G., Thiet M., Moore F.Jr., Seely E.W.: Primary hyperaldosteronismin pregnancy. A case report. J. Reprod. Med., 1996;41: 255-258
  Google Scholar
• 50. Takeuchi T., Takada Y., Funayama H.: Primary aldosteronism.Jpn. Med. J., 1998; 3878: 26-32
  Google Scholar
• 51. Tominaga T., Suzuki H., Saruta T.: A case of primary aldosteronismassociated with pregnancy. Intern. Med., 1988; 61: 563-567
  Google Scholar
• 52. Venning E.H., Dyrenfurth I.: Aldosterone excretion in pregnancy.J. Clin. Endocrinol. Metab., 1956; 16: 426-428
  Google Scholar
• 53. Watanabe H., Hayashi H., Yamamoto T., Taguchi T., Sakata K.,Tawarahara K., Masuda H., Kamikawa T., Kobayashi A., YamazakiN.: A case of primary aldosteronism which showed improvement inblood pressure during pregnancy. Shinzo, 1985; 17: 315-319
  Google Scholar
• 54. Watanabe M., Meeker C.I., Gray M.J., Sims E.A., Solomon S.:Secretion rate of aldosterone in normal pregnancy. J. Clin. Invest.,1963; 42: 1619-1631
  Google Scholar
• 55. Webb J.C., Bayliss P.: Pregnancy complicated by primary aldosteronism.South. Med. J., 1997; 90: 243-245
  Google Scholar
• 56. WHO. Guideline: Potassium intake for adults and children. Geneva,World Health Organization (WHO), 2012
  Google Scholar
• 57. WHO. Guideline: Sodium intake for adults and children. Geneva,World Health Organization (WHO), 2012
  Google Scholar
• 58. Wilson M., Morganti A.A., Zervoudakis J., Letcher R.L., RomneyB.M., Von Oeyon P., Papera S., Sealey J.E., Laragh J.H.: Blood pressure,the renin-aldosterone system and sex steroids throughout normalpregnancy. Am. J. Med., 1980; 68: 97-104
  Google Scholar

Full text