Eplerenone Use in Primary Aldosteronism During Pregnancy

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Eplerenone Use in Primary Aldosteronism During PregnancyAderville Cabassi, Rossana Rocco, o Berretta, Giuseppe Regolisti, Alberto Bacchi-Modena+ Author Affiliations1. Department of Internal Medicine, Nephrology, and Health SciencesHypertension UnitAzienda Ospedaliera Universitaria di ParmaParma, Italy (Cabassi, Rocco) 2. Department of Obstetrics and GynecologyAzienda Ospedaliera Universitaria di ParmaParma, Italy (Berretta) 3. Department of Internal Medicine, Nephrology, and Health SciencesHypertension UnitAzienda Ospedaliera Universitaria di ParmaParma, Italy (Regolisti) 4. Department of Obstetrics and GynecologyAzienda Ospedaliera Universitaria di ParmaParma, Italy (Bacchi-Modena) To the Editor:Primary hyperaldosteronism has rarely been reported in pregnancy (≈30 cases have been described since 1962) and is most often caused by an adrenal adenoma.1–2 Aggressive management is strongly recommended, because the risk of complications in both the mother and the fetus is high.3 Difficulties arise because of limited therapeutic options attributed to fetal toxicity. The following is a case report of primary aldosteronism during pregnancy, treated with eplerenone, an antagonist of mineralocorticoid receptors. In April 2009, a 34-year–old African woman, gravida 1 para 1, at 21 weeks' gestation with a male fetus, was referred to our obstetrics and gynecology department for palpitations, uncontrolled hypertension, and severe hypokalemia. Before pregnancy, normokalemia was reported, and blood pressure (BP) was controlled with nifedipine GITS-20 mg/d. At the time of admission, her BP was 155/110 mm Hg and pulse rate was 76 beats per minute. Her physical examination was normal. A fetal ultrasound showed normal growth for gestational age. A 12-lead ECG showed a sinus rhythm (82 beats per minute), supraventricular and ventricular premature beats, and a long QTc (524 ms; normal value <400 ms). A 24-hour ECG showed frequent ventricular premature beats (18 174 in 24 hours) with couplets and several runs of ventricular tachycardia. Laboratory tests revealed severe hypokalemia (K=1.9 mEq/L; normal range: 3.5–5.3 mEq/L) and hypomagnesemia (Mg=1.3 mg/dL; normal range: 1.5–2.5 mg/dL), metabolic alkalosis (pH 7.48; HCO3=32 mEq/L), and normal liver and renal function. Urinalysis showed 1+ proteinuria. Supplementations with K and … [Full Text of this Article]