Hypokalemic Quadriparesis as the Initial Manifestation of Primary Aldosteronism: A Case Report

Abstract

Introduction: Primary aldosteronism (PA) is estimated to affect approximately 5 - 10% of adults with hypertension. PA remains substantially underdiagnosed, with screening rates among adults with hypertension often below 1%. Case Presentation: A 50-year-old Gilak woman presented to our clinic with a history of severe hypertension for more than 10 years and recurrent episodes of acute quadriparesis. At presentation, she was receiving multiple antihypertensive agents. Initial examination revealed a hypertensive crisis, severe muscle weakness, profound hypokalemia, and a U wave on electrocardiography. We initiated immediate management of severe hypertension, discontinued hydrochlorothiazide, and started potassium supplementation. Measurement of serum renin and aldosterone levels showed an elevated aldosterone-to-renin ratio, raising suspicion for PA. Abdominal computed tomography identified a 2 × 1.5 cm enhancing left adrenal mass. The mass was surgically resected, and histopathology confirmed an aldosterone-producing adenoma. Conclusions: PA can rarely cause severe hypokalemia and quadriparesis. This case highlights the consequences of misdiagnosis and underscores the need for more stringent screening protocols for high-risk patients with hypertension or hypokalemia.