Presentation Type
Oral Presentation
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Liddle syndrome is a rare autosomal dominant disorder associated with abnormalities in function of the collecting tubule sodium channel, also called the epithelial sodium channel (ENaC). ENaC function is increased in the Liddle’s syndrome leading to the manifestations of mineralocorticoid excess symptoms, such as hypertension, hypokalemia, and metabolic alkalosis. The diagnosis is made when these features are seen with low renin and low plasma or urinary aldosterone. Genetic testing is not required for the diagnosis of Liddle syndrome. Liddle's syndrome has an excellent response to amiloride.
Case Presentation: A 56-year-old gentleman, with longstanding uncontrolled hypertension was seen for functional constipation and lower extremity weakness. He had no other symptoms. His initial blood pressure was 210/122. His physical exam was remarkable for a Grade 3/6 decrescendo diastolic murmur. He had normal strength and reflexes. His potassium was 2.7mEq/L bicarbonate 33.3 mEq/L and Ph 7.49. EKG shows QT prolongation and patient was tachycardic.
The patient was admitted to the hospital for treatment of his blood pressure and potassium replacement. Despite treatment, the potassium remained low and blood pressure uncontrolled. The patient described a 17-year history of poorly controlled blood pressure. He had seen multiple physicians for blood pressure management and had taken numerous medications.
An evaluation for secondary causes of hypertension was initiated. His plasma renin was low at
Conclusion: This case report demonstrates the important concept of reviewing previous treatment and wondering why the patient has a poorly controlled medical problem. Secondary causes of hypertension are less common but often improve with specific treatment In this patient, thinking about why he had resistant hypertension, hypokalemia and metabolic alkalosis led to further work-up. The low renin and low aldosterone added to the expanded history led to better blood pressure control by selecting the correct treatment. Thus, A little bit of thinking about Liddle’s can lead to big improvement in blood pressure.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Patel, Shreel; Kondapavuluru, Roy; Cho, Eunbee; Bello, Fatimah; and Garcia Cruz, Jian, "Little bit about Liddle: Big improvement in blood pressure" (2024). Research Symposium. 20.
https://scholarworks.utrgv.edu/somrs/2024/talks/20
Included in
Little bit about Liddle: Big improvement in blood pressure
Background: Liddle syndrome is a rare autosomal dominant disorder associated with abnormalities in function of the collecting tubule sodium channel, also called the epithelial sodium channel (ENaC). ENaC function is increased in the Liddle’s syndrome leading to the manifestations of mineralocorticoid excess symptoms, such as hypertension, hypokalemia, and metabolic alkalosis. The diagnosis is made when these features are seen with low renin and low plasma or urinary aldosterone. Genetic testing is not required for the diagnosis of Liddle syndrome. Liddle's syndrome has an excellent response to amiloride.
Case Presentation: A 56-year-old gentleman, with longstanding uncontrolled hypertension was seen for functional constipation and lower extremity weakness. He had no other symptoms. His initial blood pressure was 210/122. His physical exam was remarkable for a Grade 3/6 decrescendo diastolic murmur. He had normal strength and reflexes. His potassium was 2.7mEq/L bicarbonate 33.3 mEq/L and Ph 7.49. EKG shows QT prolongation and patient was tachycardic.
The patient was admitted to the hospital for treatment of his blood pressure and potassium replacement. Despite treatment, the potassium remained low and blood pressure uncontrolled. The patient described a 17-year history of poorly controlled blood pressure. He had seen multiple physicians for blood pressure management and had taken numerous medications.
An evaluation for secondary causes of hypertension was initiated. His plasma renin was low at
Conclusion: This case report demonstrates the important concept of reviewing previous treatment and wondering why the patient has a poorly controlled medical problem. Secondary causes of hypertension are less common but often improve with specific treatment In this patient, thinking about why he had resistant hypertension, hypokalemia and metabolic alkalosis led to further work-up. The low renin and low aldosterone added to the expanded history led to better blood pressure control by selecting the correct treatment. Thus, A little bit of thinking about Liddle’s can lead to big improvement in blood pressure.