The arterial hypertension (HTA) of endocrine origin, account for over half of secondary hypertension causes. This etiological entity comprises several distinct disorders, the most common being primary aldosteronism (PAHs). Its symptoms are very unspecific, but the association of hypertension with hypokalemia, should guide the investigations to confirm PAH.
We report the case of a woman of 40 years old, who has a resistant hypertension to triple therapy, the systolic blood pressure is 170 mmHg and diastolic blood pressure is 120 mmHg, with hypokalemia 1.9 mEq /L, and a high urinary potassium at 87 mEq /24h. The report Aldosterone / Renin was very high. The scan showed an adrenal mass of 23.3 mm, without abnormality of the renal arteries. A treatment based on Spironolactone has been established, and adrenalectomy thereafter. The evolution was marked by normalization of blood pressure, of serum potassium, and the rate of aldosterone.
Primary aldosteronism by Conn adenoma, now covers 10% of hypertensive patients, and should be suspected when hypokalemia is present in untreated hypertensive, or resistant to antihypertensive drugs. The diagnostics have refined: they are now more sensitive, specific and indications are more accurate, allowing better management of patients.
In this paper, we focus on the importance of interaction between adverse genetic mutations, and clinical risk factors in the development of ischemic stroke, knowing that this disease is multifactorial common that is affected by a number genetic mutations and environmental factors. The apolipoprotein E4 allele (APO e4), Factor II G20210A prothrombin (blood clotting protein), and Factor V genotypes were examined in 165 patients with ischemic Stroke group and 165 Control group, at the Laboratory of Human Genetics and Molecular Pathology, University Hassan II- Faculty of Medicine in Casablanca and the department of neurology at the campus teaching hospital of Casablanca and Rabat. Logistics regression models and bivariate correlation analysis with Karl Pearson's method were used to estimate the role of co-occurrences of the clinical risk factors and genetic mutations in ischemic stroke. The presence of the APO e4 is dominant in Stroke group than Control group and its association with hypertension, smoking and cholesterol increases the risk of ischemic stroke. FV mutation in association with hypertension or diabetes mellitus reveals a strong correlation in ischemic stroke. We found no significant relationship between the ACE D / D, FII, MTHFR 677TT genotype and clinical factors. In some combinations, pairing of adverse genetic factors, which alone confer non-significant risk, with clinical risk factors can greatly increase the risk of having an ischemic stroke.