Primary Aldosteronism: A Series of 11 Cases

Abstract

Primary Aldosteronism (PA) should be suspected in patients with resistant hypertension, early-onset hypertension, hypertension with hypokalaemia, and metabolic alkalosis. The diagnosis is often missed due to a lack of awareness and cumbersome investigations. Eleven cases of PA who attended the Endocrinology Outpatient Department (OPD) and were also admitted to the hospital over the last three years (January 2020 to January 2023) were studied, and data were collected and analysed. All 11 patients had hypertension, and five out of 11 had resistant hypertension and 36.36% (four patients) had a family history of hypertension. In this cohort, nine out of 11 patients presented with hypokalaemia (81.81%), and five of them had hypokalaemic paralysis at presentation. In 54.54% of patients, plasma aldosterone was in the range of 20-40 ng/dL, with a mean plasma Aldosterone conc. of 31.7 ng/dL. Plasma Renin Activity (PRA) was suppressed in all eight patients. In nine out of 11 patients, PAC/PRA was >20. A left-sided adrenal adenoma was observed in 54.54% of cases. Six patients (54.54%) received surgical management (laparoscopic adrenalectomy), and the remaining five patients were doing well with medical management (antihypertensives and spironolactone). This case series illustrates the need for screening of PA in patients with resistant hypertension, specifically those with hypokalaemia. Elevated PAC is diagnostic, especially in the context of suppressed PRA. Computed Tomography (CT) is the modality of choice for localising the adenoma in most cases. Clinicians can make decisions regarding the choice of treatment based on these two investigations.

Keywords

• adrenal
• adenoma
• aldosterone
• hypertension
• hypokalaemia
• renin