Primary aldosteronism presenting with hypertension and quadriparesis.

Abstract

Acta Neurologica Taiwanica Vol 16 No 4 December 2007 A 64 years old hypertensive man presented with progressive quadriparesis for 1 week. Review of his medication revealed Nifedipine 30 mg/day only. On examination, he had high blood pressure (179/115 mm Hg) with weakness of neck extensor and proximal four limbs symmetrically. Significant laboratory abnormalities included serum potassium 2.1 mmol/L and creatine kinase 1089 U/L (normal reference [NR]: 50-350 U/L). Serum creatinine, glucose, calcium, chloride, sodium, cortisol and thyroid hormone were normal. Twentyfour-hour urine collection revealed increased urinary potassium excretion (138.0 mmol/day). Analysis of arterial blood gas (ABG) under room air showed metabolic alkalosis with respiratory compensation (pH = 7.58, pCO2 = 51.2 mmHg, HCO3= 48.3 mEq/L, and SaO2 = 97.5%). The basal aldosterone was high (972 pg/mL, NR: 37-240 pg/mL), with suppressed plasma renin concentration (0.28 ng/mL, NR: 3.10-37.00 ng/mL). Abdominal computed tomography showed a nodule, 1.5 cm in size, in the left adrenal gland (Fig. A). Adrenalectomy was done and the pathological diagnosis was adrenocortical adenoma (Fig. B). His weakness, hypertension and hypokalemia all got cured after operaPrimary Aldosteronism Presenting with Hypertension and Quadriparesis