Atypical Presentation of Conn’s Syndrome

Abstract

Primary Aldosteronism (PA) is a common cause of secondary hypertension, arising from aldosterone-producing adenomas. It mostly presents with resistant hypertension, hypokalemia and metabolic alkalosis, secondary to excess secretion of aldosterone and a suppressed plasma renin activity (PRA). Hypokalemia typically presents with myalgia, cramps and muscle weakness. Rhabdomyolysis associated with hypokalemia. Paralysis represent an uncommon presentation of PA, described in few cases in medical literature. Herein, we report a 41-year-old male with an initial presentation of an acute onset paraplegia and malignant hypertension. The biochemical evaluation revealed rhabdomyolysis potentially due to severe hypokalemia. Then, investigations for primary hyperaldosteronism showed an elevated aldosterone-renin ratio (ARR). Preoperative localization study with contrast-enhanced computed tomography (CT) scan revealed a left adrenal adenoma.  Laparoscopic adrenalectomy resulted in a complete clinical resolution, normalization of kalemia, muscle enzymes and ARR.