Category: Adrenal Disorders

Monitor: 8

8 - A CASE OF PERSISTENT HYPOKALEMIA IN A NORMOTENSIVE PATIENT WITH PRIMARY ALDOSTERONISM

Friday, Apr 26
11:00 AM – 11:30 AM

Objective :

Primary aldosteronism (PA) is characterized by hypertension, hypokalemia, suppressed renin activity and increased aldosterone and was first described by J. W. Conn in 1955. The common form of PA includes arterial hypertension and hypokalemia.  Brooks et al., in 1972 challenged the view that PA exists only in patients with resistant hypertension and can exist in normotensive patients.  Thirty cases of normotensive PA have been reported, of which most patients were middle-aged and predominantly women (81%). We report a case of a young patient with no history of hypertension with persistent hypokalemia found to have PA.


Methods : n/a


Results : n/a


Discussion :

The patient is a is a 27-year-old female with no past medical history who was evaluated in endocrinology clinic for a hospital follow up due to persistent hypokalemia.  She presented to the emergency department with complaints of paresthesias, bilateral lower extremity weakness, cramps, and difficulty ambulating.  She was not taking any medication or herbal supplements and was found to have a potassium level of 2.1 mmol/L (3.4-4.9) prompting hospital admission. The patient did not present with nausea, vomiting, or diarrhea, and creatinine level was 0.7mg/dL.

The patient’s blood pressure (BP) upon arrival to the emergency department was 146/71mmHg, yet during the next two days of hospitalization her BP remained between 109-134mmHg systolic. Although the aldosterone/renin ratio (ARR) was elevated during the initial hospitalization, multiple doses of oral and IV potassium supplementation were given.  In theory this could lead to increased aldosterone secretion.  The patient was discharged on potassium supplementation.

Repeat labs in the outpatient setting showed K level: 3.3 mmol/L, plasma aldosterone concentration (PAC): 25.7 ng/dl (n1ng/ml), and ARR: of 51.4 (n < 25). Urine studies showed 24Hr U K: 101.8, mmol/day, 24 U Aldosterone: 40.8mcg/day (1.2-28.1), and 24Hr U Na: 249 mmol/day. PA was confirmed, and an aldosterone-antagonist was added to her therapy. Adrenal CT was ordered which showed a right adrenal adenoma and adrenal venous sampling (AVS) is now planned to confirm lateralization.


Conclusion :

Excess or inappropriate aldosterone activity has been associated with cardiac fibrosis, inflammation and remodeling, insulin resistance, kidney injury, and increased mortality.  Current guidelines recommend screening patients with sustained BP above 150/100 mm Hg as well as in patients with hypertension and spontaneous or diuretic-induced hypokalemia.  Persistent hypokalemia should prompt evaluation for PA in patients with no apparent etiology regardless of the presence of hypertension.

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Amanda N. Cantu

Endocrinology Fellow, PGY-4
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas

EDUCATION
MEDICAL
Universidad México Americana Del Norte A.C. Aug.2005- July 2011
Reynosa, Tamaulipas. Mexico
Médico Cirujano Partero (Physician Surgeon Midwife) July 2011

UNDERGRADUATE
University of Texas at Austin, Austin, Texas
B.A. IN BIOLOGY August 2004
B.S. IN NEUROBIOLOGY May 2004
________________________________________
CLINICAL/ WORK EXPERIENCE

PGY-4 ENDOCRINOLOGY FELLOWSHIP July 2018-Present
Texas Tech University Health Sciences Center at the
Permian Basin. Harlingen, Texas

INTERNAL MEDICINE RESIDENCY PROGRAM July 2015-June 2018
UTRGV- VBMC Internal Medicine Residency Program
Harlingen, Texas

SOCIAL/GOVERNMENT SERVICE Aug. 2010-July 2011
Unidad Medica Móvil # 11 (Mobile Health Unit
#11) Reynosa, Tamaulipas. Mexico
Jurisdicción Sanitaria IV, Área de Salud Rural
(State Health Department Jurisdiction IV Clinic
Rural Health Area)

PREGRADUATION INTERNSHIP ROTATIONS July 2009-June 2010
Hospital General de Reynosa “Dr. José María Cantú
Garza” (State of Tamaulipas Health Department’s
General Hospital); Reynosa, Tamaulipas. Mexico

________________________________________
RESEARCH
POSTGRADUATE
POSTER PRESENTATION
1.) Are Smartphones the Answer for Diabetes Control? Nov. 2017
Quality Improvement Project.
Cantu, A.N, & Ansari R. Poster presented at: Texas Chapter of the ACP.
Texas Chapter Annual Meeting; San Antonio, TX, USA

2.) What do you mean Oerskovia, Isn’t That a Contaminant? May 2017
Cantu, A. N., & Ansari, R. Poster presented at:
Texas Chapter of the ACP, Southwest Regional Meeting; Austin, TX, USA.

3.) Is it Neurosyphilis or not? A Contemporary Twist on a Historic Disease? May 2017
Cantu, A.N., & Clarke S. Poster presented at:
Society of Hospital Medicine; Las Vegas, NV, USA.

MEDICAL
MEDICAL SCHOOL THESIS
1.) “Investigación Sobre Morbilidad Asociada Aug. 2010- Jan. 2011
con Comunidades Pertenecientes a Unidad Móvil
Caravanas de la Salud 11 en el Periodo de
Agosto2010 – Enero 2011”
(Research on the Morbidity Associated
with the Rural Communities Visited by Mobile
Health Unit # 11 from August 2010 – January 2011)
Jurisdicción Sanitaria IV, Área de Salud Rural
(State Health Department Jurisdiction IV Clinic
Rural Health Area)
Reynosa, Tamaulipas. Mexico






James K. Burks

Endocrinology Fellowship Program Director
Texas Tech Health Science Center of the Permian Basin
Odessa, Texas

BIOGRAPHICAL SKETCH
Provide the following information for the key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED TWO PAGES.

NAME
James K. Burks, MD POSITION TITLE: Professor of Medicine

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
INSTITUTION AND LOCATION DEGREE
(if applicable) YEAR(s) FIELD OF STUDY
Texas Technological College, Lubbock, TX BS 1963-1967 Microbiology
Univ. Tex. Southwestern Med. School, Dallas, TX MD 1967-1971 MD
Vanderbilt, Nashville, TN Resident 1971-1973 Internal Medicine
NIH, NISMDD, Bethesda, MD Staff Assoc. 1973-1975 Admin; collagen research
Strong Mem. Hospital, Rochester, NY Fellow 1975-1976 Endocrinology
Washington Univ., St. Louis, MO Fellow 1976-1979 Endocrinology


A. Positions and Honors

Assoc. Professor of Medicine, Texas Tech of the Permian Basin, Odessa, TX 1994-2003
Program Director, Internal Medicine, Texas Tech of the Permian Basin 1996-2014
Chairman, Department of Internal Medicine, Texas Tech of the Permian Basin 2002-2004
Professor of Medicine, Texas Tech of the Permian Basin, Odessa, TX 2003-
Excellence in Teaching in Clinical Sciences, TTUHSC 1998-1999
ACGME Parker J. Palmer Courage to Teach Award 2008-2009
TTUHSC Dean’s Clinical Teaching Award 2008-2009
Program Director Endocrinology Fellowship, Texas Tech of the Permian Basin 2016-

B. Selected Publications

Adnan Haider MD, James K Burks MD, Cheema HI, MD, Angel Tejada, MD
Postprandial Hypoglycemia: Complication of peptic ulcer surgery
Am J Med 2017: 130(12); e527-529 PubMED ID 28711557

Peck, W.A., Burks, J.K., Wilkins, J., Rodan, S. B., Rodan, G.A.
Evidence for preferential effects of parathyroid hormone, calcitonin and
adenosine on bone and periosteum
Endocrinology, 1977, Volume 100(S), pp. 1357-1364

Burks, J. K., and Peck, W.A.
Bone cells: A serum-free medium supports proliferation in primary culture
Science, 1978, Volume 199, pp. 542-544

Burks, J. K., and Peck W. A,
Growth and differentiation of isolated calvarium cells in a serum-free medium
International Review of Cytology, Supplement 10, 1979, pp. 103-115:
Edited by W. W. Nichols and D. G. Murphy



C. Recent Posters and Abstracts

Haider A, Ramirez A, Siddiqui A, Burks J. Primary Adrenal Lymphoma Presenting as Bilateral Adrenal Masses (Poster presented at the AACE 26th Annual Scientific and Clinical Congress at Austin, TX, May 3-7, 2017)
Siddiqui A, Hasan S, Spellman C, Burks J. An Unusual Presentation of Graves Ophthalmopathy (Poster presented at the AACE 27th Annual Scientific and Clinical Congress at Boston, MA, May 16-20, 2018)
Chakrala J, Hasan S, Siddiqui A, Chemitiganti R, Burks J. Parathyroid Crisis in a Young Male (Poster presented at the AACE 27th Annual Scientific and Clinical Congress at Boston, MA, May 16-20, 2018)
Hasan S, Siddiqui A, Burks J. A Rare Cause of Graves Disease in HIV Infection (Poster presented at the AACE 27th Annual Scientific and Clinical Congress at Boston, MA, May 16-20, 2018)
Hassan S, Burks J. Graves' Disease and Thyroid Eye Disease in HIV Patient Due to Immune Reconstitution Inflammatory Syndrome. (100th Annual Meeting of the Endocrine Society, Chicago, IL)