A Case of Primary Aldosteronism with Tuberculosis in which it was Difficult to Control Drug-induced Hypertension, Hypokalemia, and Side Effects Preoperatively

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  • 術前管理に苦慮した肺結核併存原発性アルドステロン症の1例
  • 症例 術前管理に苦慮した肺結核併存原発性アルドステロン症の1例
  • ショウレイ ジュツゼン カンリ ニ クリョ シタ ハイケッカク ヘイソン ゲンパツセイ アルドステロンショウ ノ 1レイ

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Abstract

A 68-year-old woman who had a past history of hypertension was referred to our hospital with tuberculosis. Shortly after the start of tuberculosis treatment including rifampin (RFP), the laboratory data showed hypokalemia, and she had Grade II hypertension. RFP can reduce the antihypertensive effects of calcium channel blockers, so an additional angiotensin II receptor blocker (ARB) was given to maintain blood pressure control. Computed tomography showed a nodular lesion located in the right adrenal gland, and the laboratory data showed suppressed plasma renin activity (PRA) and a high plasma aldosterone concentration (PAC), suggesting primary aldosteronism (PA). Spironolactone was discontinued for the detailed endocrinological investigation. Grade I hypertension was seen after RFP was changed to rifabutin (RBT), but the hypokalemia did not improve. Because of the side effects of RBT, it was changed to RFP. An aldosterone-producing adenoma in the right adrenal gland was diagnosed based on the endocrinological investigation and 131I-adosterol scintigraphy. Liver dysfunction was caused by high doses of spironolactone for grade II hypertension and hypokalemia. RFP and isoniazid (INH) were discontinued, and the dose of spironolactone was reduced. Four months after the start of antituberculosis therapy, laparoscopic adrenalectomy was performed. After the operation, grade II-III hypertension and hypokalemia markedly improved to the normal range.

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