Hypertension in a patient with aldosterone deficiency

Endocr Pract. Mar-Apr 2005;11(2):104-7. doi: 10.4158/EP.11.2.104.

Abstract

Objective: To describe a patient with aldosterone synthase deficiency, who presented with failure to thrive, hypovolemic hyponatremia, and the unexpected finding of hypertension.

Methods: We present a case report, review the related literature, and outline a possible mechanism for the concomitant occurrence of high blood pressure and hyponatremia in this patient.

Results: A 5-month-old infant with unambiguous female genitalia was admitted to our hospital with failure to thrive and hyponatremia. Her blood pressure was 115/88 mm Hg (>95% for age). The serum sodium concentration was 123 mEq/L (normal for age, >130), and the potassium level was 5.3 mEq/L (normal, 3.5 to 5.3). A direct renin measurement by immunochemiluminescence assay was 11,400 microU/mL (normal, <5), and the aldosterone level was 4 ng/dL (normal, 2 to 70). These findings indicated a diagnosis of aldosterone synthase deficiency. Treatment with fludrocortisone and sodium chloride was begun, but the hypertension worsened. Therapy with an angiotensin-converting enzyme inhibitor was transiently required.

Conclusion: Angiotensin II, a potent vasoconstrictor, is an intermediate in the renin-angiotensin system. We believe that this protein was the cause of the hypertension in the setting of aldosterone deficiency in our patient.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Cytochrome P-450 CYP11B2 / deficiency
  • Drug Therapy, Combination
  • Failure to Thrive
  • Female
  • Fludrocortisone / adverse effects
  • Fludrocortisone / therapeutic use
  • Humans
  • Hypertension / drug therapy
  • Hypertension / etiology*
  • Hypertension / physiopathology
  • Hypoaldosteronism / complications*
  • Hypoaldosteronism / etiology
  • Hypoaldosteronism / physiopathology
  • Hyponatremia / etiology
  • Infant
  • Sodium Chloride / adverse effects
  • Sodium Chloride / therapeutic use
  • Steroid Metabolism, Inborn Errors / complications

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Sodium Chloride
  • Cytochrome P-450 CYP11B2
  • Fludrocortisone