Abstract
A 47-year-old diabetic woman with moderate renal disturbance and mitral insufficiency had unexplained hyperkalemia, which was aggrevated by sodium restriction and pragressed after severe hyperglycemia improved and edema disappeared. The plasma renin activity (PRA) and plasma aldosterone concentration (PA) were low and unchanged by two-hours standing or infusion of furosemide. The plasma cortisol level and response to ACTH stimulation were normal. The responses of PA to ACTH and angiotensin II infusion were slightly decreased, but the plasma deoxycorticosterone and corticosterone after such stimulations were normal. Following infusion of 50 g glucose, there was a paradoxical increase in serum potassium levels in this patient. Histologically, the juxtaglomerular apparatus was not completely observed, but partial hyalinization of afferent arterioles was not observed. The abnormalities of potassium homeostasis in this patient were probably related to insulin and aldosterone combined deficiency.
