Quadriparesis, hypokalemia, and severe hypertension: a case report of primary hyperaldosteronism

Abstract

Arterial Hypertension (HTN) is the main risk factor for cardiovascular and renal disease. While most cases are classified as essential hypertension, 5-10% are attributed to secondary HTN. Secondary HTN should be considered in individuals under 35 years of age, with resistant HTN, severe HTN of sudden onset, or associated hypokalemia. Primary aldosteronism (PA) is a common cause of secondary HTN, particularly in cases of resistant HTN. PA is characterized by elevated aldosterone levels, which lead to the typical triad: HTN, hypokalemia, and metabolic alkalosis. It is essential for healthcare professionals to promptly recognize PA, as early and appropriate treatment can reduce cardiovascular and cerebrovascular complications, which are more prevalent compared to other forms of HTN.

We report the case of a 63-year-old male patient who presented with muscle weakness, which progressively worsened, eventually resulting in the inability to walk. He exhibited severe quadriparesis, without sensory symptoms or signs of neurological focality, and HTN of 190/100 mmHg. Laboratory tests revealed severe hypokalemia and metabolic alkalosis. The patient had a history of resistant HTN since the age of 45, treated with four antihypertensive drugs (valsartan, amlodipine, hydrochlorothiazide, and carvedilol) without achieving adequate control. After admission, plasma aldosterone and renin levels were measured, showing an ARR index of 250, confirming the diagnosis of PA. Parenteral potassium replacement was administered, and treatment with spironolactone and valsartan was initiated. An abdominal CT scan revealed an adrenal adenoma. The patient was started on spironolactone and valsartan. He showed favorable progression, regaining muscle strength and achieving normalization of blood pressure and potassium levels in subsequent follow-ups.

PA is a common cause of secondary HTN that should be suspected in young patients with difficult-to-control HTN or hypokalemia. In this case, the patient had gone undiagnosed and untreated for years. This case highlights the importance of considering PA in resistant HTN, emphasizing its therapeutic management and the need for education about this condition in clinical practice.