RESUMO
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.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações na Gravidez/fisiopatologia , Hiperaldosteronismo/fisiopatologia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/tratamento farmacológicoRESUMO
The first hundred laparoscopies carried out in the "Hospital Parroquial de San Bernardo", between november 1986 and june 1988; were evaluated. The indications for the procedure were: 38% study of infertility, in which a 78% of tubal obstruction or adherencial syndrome was demonstrated; 37% because of ectopic pregnancy, with a diagnostic correlation of 48.6%. The remainder cases were adnexal masses or pelvic pain study. A 42% of the patients had previous pelvic or abdominal surgery. As complications there were two "pre-pneumoperitoneaum", one pelvic inflammatory process and one anesthetic accident, hospitalization time and costs, justifies completely the acquisition of the necessary equipment and technical ability.