Rhabdomyolysis as first presentation of the Conn’s syndrome: a clinical case
, 2, 3, 4, 5, 1
Abstract
Primary hyperaldosteronism is the leading cause of secondary hypertension, often presented with hypokalemia and even rare with its consequences. We describe a case of a 62-year-old man admitted to the emergency department with rhabdomyolysis from severe hypokalemia. Hypertension with hypokalemia and metabolic alkalosis should bring to the doctor’s attention the possibility of primary aldosteronism, which should also be confirmed by elevated plasma aldosterone concentration, a decreased plasma rennin levels, and high aldosterone/rennin ratio. The diagnosis of primary hyperaldosteronism was confirmed by an abdominal computed tomography, which revealed a solid mass at the posterior crus of the left adrenal gland. After the treatment of hypokalemia, neuromuscular symptoms regressed.
Blood pressure and potassium levels normalized after laparoscopic adrenalectomy were performed. This rare clinical case highlights the diversity of the clinical presentation of primary hyperaldosteronism and emphasizes the need to be alert to the possibility of the presence of primary hyperaldosteronism in a patient who presents with hypertension and rhabdomyolysis induced by severe hypokalemia.
Keywords: rhabdomyolysishypokalemiametabolic alkalosisConn’s syndrome
References
- Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016; 101(5): 1889–1916.
- Faconti L, Kulkarni S, Delles C, et al. Diagnosis and management of primary hyperaldosteronism in patients with hypertension: a practical approach endorsed by the British and Irish Hypertension Society. J Hum Hypertens. 2024; 38(1): 8–18.
- Wang WH, Yue P, Sun P, et al. Regulation and function of potassium channels in aldosterone-sensitive distal nephron. Curr Opin Nephrol Hypertens. 2010; 19(5): 463–470.
- Díaz-López EJ, Villar-Taibo R, Rodriguez-Carnero G, et al. Should we suspect primary aldosteronism in patients with hypokalaemic rhabdomyolysis? A systematic review. Front Endocrinol (Lausanne). 2023; 14: 1257078.
- Stanley M, Chippa V, Aeddula NR, et al. Rhabdomyolysis. [Updated 2023 Apr 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 . https://www.ncbi.nlm.nih.gov/books/NBK448168/.
- Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve. 2002; 25(3): 332–347.
- Allison RC, Bedsole DL. The other medical causes of rhabdomyolysis. Am J Med Sci. 2003; 326(2): 79–88.
- Zavatto A, Concistrè A, Marinelli C, et al. Hypokalemic rhabdomyolysis: a rare manifestation of primary aldosteronism. Eur Rev Med Pharmacol Sci. 2015; 19(20): 3910–3916.
- Gumz ML, Rabinowitz L, Wingo CS. An Integrated View of Potassium Homeostasis. N Engl J Med. 2015; 373(1): 60–72.
- Gonerska-Szadkowska A, Wittych-Długosz J, Rzymski P, et al. Rhabdomyolysis following severe hypokalemia caused by Conn’s syndrome. Arch Med Sci. 2007; 3(3): 274–277.
- Bokhari SRA, Zulfiqar H, Mansur A. Bartter Syndrome. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK442019/ (2019).
- Mubarik A, Anastasopoulou C, Aeddula NR. Liddle Syndrome (Pseudo hyperaldosteronism) [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK536911/.
- Palmer BF. Regulation of Potassium Homeostasis. Clin J Am Soc Nephrol. 2015; 10(6): 1050–1060.
- Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004; 89(3): 1045–1050.
- Huang YY, Hsu BR, Tsai JS. Paralytic myopathy--a leading clinical presentation for primary aldosteronism in Taiwan. J Clin Endocrinol Metab. 1996; 81(11): 4038–4041.
- Pons Fernández N, Moreno F, Morata J, et al. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocr Metab Disord. 2019; 20(1): 27–36.
- Kempers MJE, Lenders JWM, van Outheusden L, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009; 151(5): 329–337.