Primary aldosteronism in pregnancy--should it be treated surgically?

We report a case of primary aldosteronism in pregnancy that was treated surgically by removal of the adenoma in the 2nd trimester. Only a few cases have been reported in the English literature due to the rarity of the condition. Primary aldosteronism follows a variable course in pregnancy. In the majority of cases the hypertension and hypokalaemia are made worse, necessitating antihypertensive medication to control the blood pressure. Some of the drugs required for treatment are known to affect the fetus. In a minority of cases the hypertension improves with pregnancy. This is thought to be due to the high levels of progesterone which is an aldosterone antagonist. Primary aldosteronism invariably gets worse in the post partum period, irrespective of the antenatal course of the disease. Surgery seems to be the treatment of choice for this condition, provided the adenoma is localised. It has the advantage of offering an immediate solution, avoids fetal complications of medical treatment and possible deterioration in the post partum period.