Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although primary aldosteronism (PA) has been reported as a relatively benign form of hypertension and is associated with low incidence of vascular complications, recent reports indicate that PA complicated by cerebral vascular accidents is not rare. The authors reported here that a 57-year-old man was diagnosed as a case of PA 4 years after initial treatment of intracerebral hemorrhage (ICH) and hypertension. The patient was transferred to our department for further management of his left hemiplegia and hypertension after surgical treatment for a putaminal ICH at the age of 53. During the first 2 years of follow-up, he did well except for an episode of transient motor weakness. Diastolic hypertension was moderately good, controlled by calcium antagonists and ACE inhibitors. Laboratory data was normal, and the serum potassium levels were in the lower limits of normal. In the last 2 years, episodes of motor weakness have increased. He was admitted to our hospital, under the suspicion of recurrent Todd's paralysis. The serum potassium level ranged from 1.9 to 2.1 despite administration of potassium agents. Abdominal CT scans and 131 I-scintigraphy disclosed a left adrenal tumor. Elevation of plasma aldosterone and suppression of plasma renin were observed. The diagnosis of PA due to hypersecretion of aldosterone from an adrenal tumor was thus confirmed. We performed a total left adrenectomy 4 weeks after his admission. Histological examination showed a clear-cell type of benign adrenal adenoma. After the operation, laboratory data were normal and ACE inhibitors were able to normalize his diastolic hypertension. According to the literature, PA complicated by ICH is associated with a high rate of recurrence of cerebral vascular accidents if treatment of PA is not performed. Although diagnosis of PA in the early stage is difficult, as it was in our presented case, high suspicion of PA is essential for patients with diastolic hypertension and persistent hypopotassiumemia, particularly in young adults and middle-aged patients.
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PMID:[Primary aldosteronism presented with intracranial hemorrhage]. 1168 Oct 14

Based on two patients, we discuss the difficulties in diagnosing and managing primary aldosteronism in pregnancy, which derive from changes of the renin-angiotensin-aldosterone axis, from the uncertainty regarding blood pressure control along gestation and postpartum, and from the contraindication to the use of spironolactone. The first case is a 27 years old woman with a long standing refractory hypertension, a hemorrhagic stroke with left brachial hemiplegia and crural hemiparesia, two miscarriages, one stillbirth and one offspring with intrauterine growth retardation. Due to hypokalemia, a plasma aldosterone/renin activity ratio of 91, and a negative genetic screening for glucocorticoid remediable aldosteronism (GRA), a primary hyperaldosteronism with normal adrenals in CT scan was diagnosed, and good blood pressure control was attained with spironolactone. After two and a half years of normotension, a fifth pregnancy, managed with methyldopa evolved with satisfactory blood pressures, plasma potassium, fetal growth, uterine and umbilical arterial resistance indexes, and maternal endothelial function. At 37 1/2 weeks of pregnancy the patient delivered a healthy newborn weighing 2,960 g. Blood pressure rose during the 48 hours of postpartum in the absence of proteinuria and required i.v. hydralazine. The second patient is a 37 years old woman, with known refractory hypertension for 7 years, hypokalemia, plasma aldosterone/renin activity ratio greater than 40, normal adrenals in the CAT scan, and a negative genetic screening for GRA. She had normotensive pregnancies 5 and 3 years prior to the detection of hypertension, with hypertensive crisis in both postpartum periods, retrospectively considered as expressions of primary hyperaldosteronism.
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PMID:[Primary aldosteronism and pregnancy: report of 2 cases]. 1261 Dec 41