Hypokalemia induced myopathy as first manifestation of primary hyperaldosteronism - an elderly patient with unilateral adrenal hyperplasia: a case reportReport as inadecuate




Hypokalemia induced myopathy as first manifestation of primary hyperaldosteronism - an elderly patient with unilateral adrenal hyperplasia: a case report - Download this document for free, or read online. Document in PDF available to download.

Cases Journal

, 2:6813

First Online: 16 July 2009Received: 24 March 2009Accepted: 30 May 2009DOI: 10.4076-1757-1626-2-6813

Cite this article as: Kotsaftis, P., Savopoulos, C., Agapakis, D. et al. Cases Journal 2009 2: 6813. doi:10.4076-1757-1626-2-6813

Abstract

IntroductionPrimary hyperaldosteronism is only rarely caused by unilateral adrenal hyperplasia.

Case presentationA 73-year-old hypertensive Greek man on 10 mg amlodipine for the last ten years presented in the emergency department with severe muscle weakness of all limbs. The initial physical and laboratory examination revealed normal blood pressure, muscle weakness, severe hypokalemia, sinus rhythm and U wave, rhabdomyolysis and metabolic alkalosis. The patient was immediately treated with intravenous administration of potassium-rich solutions, 25 mg spironolactone with progressive dose titration up to 100 mg. Because of high arterial blood pressure, irbesartan was added. On day 6, muscle weakness was completely restored with decrease of arterial blood pressure and further improvement of laboratory tests. The combination of hypokalemia with arterial hypertension raised the suspicion of primary hyperaldosteronism; therefore, we performed abdomen computed tomography scan, which revealed a nodular mass 15 mm in diameter in the left adrenal gland. Plasma renin activity was in the lower normal range with a three-fold increase of plasma aldosterone concentration. We performed total resection of the left adrenal gland and the histopathological examination revealed hyperplasia of the left adrenal gland.

ConclusionThis report presents a rare case of an elderly patient under antihypertensive treatment the last ten years for essential hypertension, who admitted to our emergency department with hypokalemia - induced myopathy as first manifestation of primary hyperaldosteronism due to unilateral adrenal hyperplasia.

AbbreviationsACTHadrenocorticotropic hormone

APAaldosterone-producing adenoma

CPKCreatinine Phosphokinase

CTComputed Tomography

IHAidiopathic hyperaldosteronism

MRIMagnetic Resonance Imaging

PACplasma aldosterone concentration

PHPrimary hyperaldosteronism

PRAplasma renin activity

UAHUnilateral adrenal hyperplasia.

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Author: Panagiotis Kotsaftis - Christos Savopoulos - Dimitrios Agapakis - George Ntaios - Valentini Tzioufa - Vasilios Papadopoulos

Source: https://link.springer.com/







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