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In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism

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Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.

About the Authors

O. V. Tsygankova
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science; Novosibirsk State Medical University
Russian Federation

Oksana V. Tsygankova – MD, PhD, Professor, Chair of Emergency Therapy with Endocrinology and Occupational Pathology, Novosibirsk State Medical University; Senior Researcher, Laboratory for Clinical, Biochemical and Hormonal Research of Therapeutic Diseases, Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science

B. Bogatkova ul. 175/1, Novosibirsk, 630089, 

Krasny prospect 52, Novosibirsk, 630091

T. I. Batluk
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science
Russian Federation

Tatiana I. Batluk – Postgraduate Student

B. Bogatkova ul. 175/1, Novosibirsk, 630089

L. D. Latyntseva
Institute of Internal and Preventive Medicine – Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science
Russian Federation

Lyudmila D. Latyntseva – MD, PhD, Head of Therapeutic Department, Senior Researcher, Laboratory of Emergency Cardiology

B. Bogatkova ul. 175/1, Novosibirsk, 630089

E. V. Akhmerova
City Clinical Polyclinic №16
Russian Federation

Elena V. Akhmerova – MD, PhD, Head of City Endocrinology Center

Parhomenko pervyj per. 32 Novosibirsk, 630078

N. M. Akhmedzhanov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Nadir M. Akhmedzhanov – MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention

Petroverigsky per. 10, Moscow, 101990


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For citations:

Tsygankova O.V., Batluk T.I., Latyntseva L.D., Akhmerova E.V., Akhmedzhanov N.M. In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism. Rational Pharmacotherapy in Cardiology. 2020;16(4):557-563. (In Russ.)

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