Primary Aldosteronism with Rhabdomyolysis: A Case Report

Abstract

Background: Most cases of primary aldosteronisms present classic symptoms such as refractory hypertension, hypokalemia, elevated aldosterone and inhibition of renin, and angiotensin. However, some cases with rare clinical manifestations, such as skeletal muscle damage with elevated serum muscle enzymes [rhabdomyolysis], are more difficult to diagnose, and may result in a delayed clinical management.

Findings: This paper reports a case of primary aldosteronism presented with rhadomyolysis due to severe hypokalemia. A 43-year-old male with a seven-year history of hypertension was admitted to the hospital with skeletal muscle weakness which he thought progressed rapidly over a period of four days, and resulted in quadriplegia for the preceding 12 hours. His laboratory tests showed hypokalemia [1.7 mmol/l] with elevations of serum creatine kinase and myocardial enzymes. An abdominal computed tomography revealed a 1.4 cm hypodense mass in the right adrenal gland, which suggested adrenocortical adenoma. He was treated with potassium and a laparoscopic adrenalectomy was performed. During one-year follow up, his blood pressure and serum potassium remained normal without the use of medications.

Conclusions: The physicians should be aware of the potential for primary aldosteronism to cause severe hypokalemia and hypokalemic rhabdomyositis. That condition should be included in the differential diagnosis of muscle weakness.

• Hypertension
• hypokalemia
• muscle enzyme
• primary aldosteronism
• rhabdomyolysis