Primary aldosteronism during pregnancy: Case report and literature review

Abstract

We present the case of a 40-year-old woman who experienced severe hypertension during her first pregnancy. Hypertension persisted after delivery, prompting admission to the Department of Endocrinology and Metabolism at our hospital. Examination revealed an aldosterone-producing adenoma, and she was diagnosed with primary aldosteronism. Her hypertension was controlled using methyldopa. She became pregnant again in April 2019, and in the ninth week of pregnancy, she underwent her first medical examination of the artery. Subsequently, the methyldopa dose was increased to control her hypertension. However, her hypertension worsened, and she tested positive for urinary albumin, prompting hospital admission at 32 weeks of gestation. Her oral medication was changed to nifedipine, which was continued after her second delivery. However, her hypertension persisted. Therefore, a selective mineralocorticoid receptor antagonist was administered, and her hypertension improved. Mineralocorticoid receptor antagonists should be considered when blood pressure is poorly controlled owing to worsening primary aldosteronism.