Hiperaldosteronismo primario y embarazo: Lecciones obtenidas de 2 casos clínicos

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 iv 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 (rev méd chile 2002; 130: 1399-1405)