Hyperkalemia was one of the complications after primary
aldosteronism surgery.
Hyperkalemia after primary
aldosteronism surgery was uncommon in clinical practice, especially persistent and serious
hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious
hyperkalemia after primary
aldosteronism adrenal
adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic
adrenalectomy due to primary
aldosteronism.
Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma
potassium was 7.0 mmol/L. The patient felt skin itchy,
nausea, palpitation. Plasma
aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary
potassium excretion declined. Decrease of
aldosterone levels after surgery might be the cause of
hyperkalemia.
Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary
aldosteronism", "
hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of
hyperkalemia after primary
aldosteronism surgery was 6% to 29%. Most of them was mild to moderator
hyperkalemia (plasma
potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in
hyperkalemia patients was persistent
hyperkalemia. Previous studies in the levels of plasma
potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of
hyperkalemia was not consistent in the published studies. Risk factors of
hyperkalemia after primary
aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of
hyperkalemia complication after primary
aldosteronism surgery. Plasma
potassium should be monitored closely after primary
aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious
hyperkalemia, and need medicine treatment.