Primary hyperaldosteronism with neurological manifestations

Primary hyperaldosteronism (PHA) is one of the most common causes of secondary hypertension but its association with neurological manifestations are not as common. We report the case of a 68-year-old woman with sudden onset asymmetrical paresis and pain. Her laboratory results showed hypokalemia and an elevated aldosterone/renin ratio. An abdominal CT scan showed an adenoma in the left adrenal gland. The patient began pharmacological treatment and was further referred to surgical treatment. We recommend clinicians to maintain a high level of suspicion in patients with atypical neurological findings to consider endocrinological disorders. PHA refers to disorders in which the production of aldosterone is abnormally high, that increases sodium reabsorption and loss of potassium and hydrogen ions. Most common causes of PHA include adrenal adenoma, unilateral or bilateral adrenal hyperplasia.  Symptoms include headaches, hypertension, polyuria, weakness, paralysis and disturbances of cardiac rhythm. Exact prevalence of PHA is unclear, but some estimates suggest that 5-15%.  After start of specific treatment  her neurological condition improved, on the discharge a proximal paresis in the left leg still persisted, pain significantly decreased and she was able to walk without support. The diagnosis based on investigational findings are consistent with PHA with intermittent hypokalemia with secondary intermittent asymmetrical proximal lower paraparesis. Patient is discharged for further endocrinological council to decide the operative treatment of adenoma.