Hiperaldosteronismo primário, como descrito por Conn. Relato decaso / Hyperaldosteronism, as described by Conn. Case report

O hiperaldosteronismo primário é causa de hipertensão arterialsecundária, com possibilidade de cura após cirurgia em 30a 75% dos casos. O objetivo deste estudo foi relatar um casode hipertensão arterial secundária a adenoma adrenal produtorde aldosterona. Paciente feminino, 35 anos, natural de Beruri(AM), procedente de Manaus, foi admitida com pressão arterialde 220x125mmHg associada a fraqueza muscular de membrosinferiores e câimbras. Na história patológica pregressa, havia orelato de hipertensão arterial diagnosticada há 2 anos, em tratamentocom três classes de anti-hipertensivos. Durante internaçãoem hospital geral, o quadro relatado associado à hipocalemiae alcalose metabólica sugeriram diagnóstico de hipertensão arterialsecundária a hiperaldosteronismo primário. Níveis elevadosde aldosterona plasmática, com renina suprimida e relação aldosterona-renina elevada, confirmaram o diagnóstico de hiperaldosteronismoprimário. A tomografia computadorizada deabdome evidenciou lesão tumoral com 2,3x2,0cm em glândulasuprarrenal esquerda sugestiva de adenoma adrenal. Pacientefoi submetida a adrenalectomia à esquerda com histopatologiacompatível com adenoma adrenal. Seis meses após a cirurgia,paciente evoluiu com normalização da calemia, porém mantevehipertensão arterial com necessidade de terapia anti-hipertensiva,sem novos picos hipertensivos. Se hiperaldosteronismo primáriodiagnosticado precocemente, há possibilidade de cura dahipertensão arterial secundária após adrenalectomia, reduzindo o efeito deletério da mesma sobre os sistemas cardiovascular, cerebrovasculare renal.(AU)

The primary hyperaldosteronism is a cause of secondaryhypertension, with the possibility of healing after surgery in 30to 75% of cases. The objective of this study was to report a caseof secondary hypertension to aldosterone-producing adrenaladenoma. A female patient, 35 years, from Beruri (AM), Brazil,who came to Manaus, was admitted into the emergency room withblood pressure of 220x125mmHg, associated with lower limbmuscle weakness and cramps. In the past medical history, there wasa report of hypertension diagnosed 2 years before, and she was undertreatment with three classes of antihypertensive drugs. Duringhospitalization in a general hospital, the case reported associatedto hypokalemia and metabolic alkalosis suggested a diagnosis ofhypertension secondary to primary hyperaldosteronism. Elevatedlevels of plasmatic aldosterone, suppressed renin and highaldosterone-renin relation suggested primary hyperaldosteronism.The abdominal computerized tomography scan revealed a tumor of2.3x2.0cm in the left adrenal gland, suggesting adrenal adenoma.Patient underwent left adrenalectomy and histopathology wascompatible to adrenal adenoma. After 6 months of surgery, thepatient experienced normalization of kalemia but kept arterialhypertension, requiring anti-hypertensive therapy, but had no othershypertensive peaks. Early diagnosis of primary hyperaldosteronismallowed the cure of hypertension after adrenalectomy, reducingdeleterious effects of high blood pressure levels on the cardiovascular,cerebrovascular and renal systems.(AU)

Adrenalectomía a incisión mínima lumbar video asistida / Adrenalectomy at lumbar minimal incision assisted by video

Se presenta una nueva técnica de adrenalectomía a incisión mínima video asistida, que permite efectuar una intervención quirúrgica muy precisa, segura y no traumática. Se destaca la buena tolerancia, disminución del dolor y la rápida deambulación y alta. Este método mixto auna las ventajas de la cirugía abierta y de los métodos endoscópicos percutáneos que utilizan óptimas y cámaras videoscópicas

Striae gravidarum ther realtion to adrenal cortical hyperfunction

The gravidarum should no longer be considered as atrech marks. There is strong evidence that they are closely related to adrenal cortical hyperactivity.In a study of 116 primigravid pregnancies it was shown that:The formation of striae gravidarum does not depend directly upon skin stretching this only influences the production of striae in the presence of a striae factor.There is a close realtion between lowered gluose tolerance in late pregnancy and the development of striase gravidarum.There is a cloise relation between acne, a sign of adrenal cortical hyperactivity and breast striae particulary as regards tine of onset.Several other clinical findings all lend support to an association between striae gravidarum and adrenal cortical hyperactivityOlive oil massage does not prevent striae gravidarum.The substance of this papaer was included in a thesis accepted by the University of Adelaide for the degree o M.D.I am grateful to Sandoz Ltd, Australia, for defraying the total expenses of this study.