A Case Of Postileostomy Hypovolemia Presenting As Pseudohypoaldosteronism With Complete Resolution After Ostomy Reversal

Abstract

Objective: To report a rare case of postileostomy hypovolemia presenting as pseudohypoaldosteronism with complete resolution after ostomy reversal. Methods: Clinical and biochemical data and extensive relevant literature review are provided. Results: A 65-year-old female was found to have a large rectal tubular adenoma 10 cm from the anal verge on colonoscopy. She underwent open resection of the polyp and diverting loop ileostomy. Six weeks later, she presented with low appetite, a 17-pound weight loss, and hypotension. Biochemical work-up revealed hyponatremia, hyperkalemia, low bicarbonate level, hypercalcemia, and remarkably elevated aldosterone and renin levels. All of the above abnormal clinical and biochemical findings had normalized after the ileostomy reversal. Conclusion: We report a case of postileostomy hypovolemia presenting as pseudohypoaldosteronism with complete resolution after ostomy reversal. It is probably not uncommon for patients with ileostomy to develop similar acid-base and electrolyte imbalances that resolve by volume repletion. Understanding the pathogenesis is critical to avoid unnecessary use of mineralocorticoids. AACE Clinical Case Rep. 2017;3:e5-e7