High Plasma Renin Activities in Primary Aldosteronism with Malignant Hypertension

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Abstract
Primary aldosteronism usually shows mild hypertension and is characterized by suppression of plasma renin activity (PRA) and elevation of plasma aldosterone concentration (PAC). Almost all previously reported cases of malignant hypertension associated with primary aldosteronism showed low PRA save one. This patient is the 2nd case of primary aldosteronism with high PRA. A 34-yr-old man was admitted because of severe hypertension, renal insufficiency and papilledema. PRA and PAC were abnormally high, 4.6 ng/ml per h and 23.0 ng/100 ml, respectively. Serum cortisol levels and urinary catecholamine excretion were within normal ranges. Serum K was normal, ranging from 3.6-4.9 meq/l. In spite of strong anti-hypertensive drugs, peritoneal and hemodialysis, the patient died of pulmonary infection .apprx. 3 mo. later. Postmortem examination revealed a right adrenocortical tumor 8 mm in diameter. Histologically, the tumor consisted of large clear cells; that was adenomatous hyperplasia characteristic in primary aldosteronism. Neither juxtaglomerular tumor nor renal artery stenosis was found. PRA in primary aldosteronism could rise with progress of renal involvement as secondary changes due to long-standing and untreated hypertension. Normal serum K could be explained by retention of K due to severely disturbed renal function, exceeding K loss through aldosterone action. Normokalemia and elevated PRA can be encountered under these circumstances.

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