Manish Tripathi
Primary Hyperaldosteronism is an underdiagnosed cause of hypertension. The classic presentation of PA includes hypertension and hypokalemia. However, in reality, most patients will present without hypokalemia. The two primary causes are aldosterone-producing adenomas (33%) and bilateral adrenal hyperplasia of the zona glomerulosa (66%). Familial cases have been found and are classified into Type I, Type II, and Type III familial hyperaldosteronism. Diagnosis can initially be confirmed with the elevated morning aldosterone to plasma renin activity ratio. If the ratio is higher than 20 to 1; then the excess aldosterone points to the adrenal gland as the primary source. The preferred treatment is adrenalectomy in those with unilateral disease. Those who are poor surgical candidates or have bilateral adrenal hyperplasia can be treated medically with mineralocorticoid antagonists as well as antihypertensive agents for further blood pressure control. We have a patient who presented in the emergency with uncontrolled hypertension (on 3 antihypertensive drugs) and unexplained hypokalemia. On further evaluation, she was detected to have metabolic alkalosis. On the above findings, she was suspected to have Primary hyperaldosteronism and was evaluated accordingly