{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T23:59:45Z","timestamp":1762473585666,"version":"build-2065373602"},"reference-count":6,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":292,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Endocrinology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Type IV renal tubular acidosis (RTA) is the only RTA characterized by hyperkalemia, and it is caused by a true aldosterone deficiency or renal tubular aldosterone hyporesponsiveness. It is frequent among hospitalized patients as it is related to type 2 diabetes mellitus (T2DM) and common medications such as ACE\u2010inhibitors (ACE\u2010is) and trimethoprim\u2010sulfamethoxazole (TMP\u2010SMX). Drug\u2010induced RTA commonly manifests in patients with predisposing conditions such as mild renal insufficiency and certain pharmacological therapies. ACE\u2010i use and chronic adrenal insufficiency (cAI) are other significant risk factors. Chronic ACTH suppression is thought to induce global adrenal atrophy, including the zona glomerulosa, thus affecting aldosterone secretion as well. Furthermore, in the setting of cAI, treatment with ACE\u2010is further suppresses aldosterone production. This case report describes a patient with cAI secondary to corticosteroid use for years who developed type IV RTA in the setting of lisinopril use. Potassium (K) elevation persisted despite removing underlying conditions and metabolic acidosis correction. The patient required long\u2010term treatment with mineralocorticoids in addition to sodium bicarbonate to maintain normal K levels and acid\u2010base status. Mineralocorticoid administration is a second\u2010line treatment for type IV RTA, but it might be necessary for a subgroup of high\u2010risk patients. In fact, it is important to consider patients with chronic adrenal insufficiency and on ACE\u2010is treatment at increased risk for refractory hyperkalemia in the setting of type IV RTA. Indeed, this subgroup of patients can have severe hypoaldosteronism.<\/jats:p>","DOI":"10.1155\/2020\/8897112","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T22:50:10Z","timestamp":1603147810000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Type IV RTA in Chronic Adrenal Insufficiency and Concomitant Lisinopril Treatment"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0744-2541","authenticated-orcid":false,"given":"Francesca","family":"Galbiati","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008020166"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2018.05.004"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200022030-00006"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2017.10.01"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2016.00072"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007135517950"}],"container-title":["Case Reports in Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crie\/2020\/8897112.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crie\/2020\/8897112.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/2020\/8897112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T23:57:28Z","timestamp":1762473448000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/2020\/8897112"}},"subtitle":[],"editor":[{"given":"Osamu","family":"Isozaki","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":6,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1155\/2020\/8897112"],"URL":"https:\/\/doi.org\/10.1155\/2020\/8897112","archive":["Portico"],"relation":{},"ISSN":["2090-6501","2090-651X"],"issn-type":[{"type":"print","value":"2090-6501"},{"type":"electronic","value":"2090-651X"}],"subject":[],"published":{"date-parts":[[2020,1]]},"assertion":[{"value":"2020-07-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8897112"}}