妊娠時に診断された原発性アルドステロン症に対し腹腔鏡下副腎摘除術を行った1例

Abstract

Primary aldosteronism (PA) during pregnancy is an extremely rare condition that may cause lifethreatening complications both for the mother and the fetus. A pregnant 31-year-oldwoman was referred to our hospital for the management of severe pregnancy hypertension at the beginning of her pregnancy. Her plasma aldosterone concentration (PAC) was markedly elevated (337 pg/ml), plasma rennin activity was suppressed (0.4 ng/ml/hr) and magnetic resonance imaging showed a 1.5 cm left adrenal tumor. PA due to an aldosterone producing-adenoma was diagnosed. Because of progressive uncontrollable hypertension and hypokalemia, a laproscopic adrenalectomy was performed at 24 weeks of gestation. The transabdominal approach was completed without any complication, resulting in normalization of PAC, easier management of bloodpressure and improvement of hypokalemia. Because of severe pregnancy hypertension, cesarean operation was performed at 30 weeks of gestation and a girl weighing 1, 235 g was delivered. The literature regarding PA during pregnancy was reviewed and the optimal timing of laparoscopic adrenalectomy during pregnancy and perioperative management were discussed.