Intermittent hyperaldosteronism. Is this an entity?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 53-73-Primary Aldosteronism & Mineralocorticoid Excess
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-67
Rajeev Sharma*1, Jocelyne Georges Karam2 and Elizabeth Sedlis Singer2
1SUNY Downstate Medical Center, Brooklyn, NY, 2Maimonides Medical Center, Brooklyn, NY
Background: Primary hyperaldosteronism is a known but commonly overlooked cause of hypertension in general population. Herein, we describe a case with atypical presentation, so called intermittent hyperaldosteronism.

Case report: 25 year-old Chinese man with no medical history was admitted with generalized muscle weakness and fatigue of few weeks duration. On presentation, BP was 160/104, and pulse 74. History was negative for polyuria, vomiting or diarrhea. No use of diuretics, liquorice, excessive soda, laxatives or OTC’s. Laboratory tests showed K 1.8 mEq/L, Na 142, Cl 98, HCO3- 32, Mg 2.1, normal renal and thyroid functions. Urinary K+ was 22 mmol/L.  EKG showed U waves in lateral leads. Potassium was replaced aggressively. CT abdomen showed 1.5 cm enhancing right adrenal nodule. Renin/aldosterone was sent on two occasions before and after K replacement. Overnight 1 mg dexamethasone suppression test and plasma metanephrines were normal. Patient was discharged with K tablets, hydralazine and verapamil. The initial aldosterone level was 5 ng/dL with plasma renin 0.08 ng/ml/hr and ARR 62 (Serum K 3.4). Repeat aldosterone level after K replacement (K- 4.4) was 4 ng/dL. Patient did not fulfill the diagnostic criteria of primary hyperaldosteronism (both aldosterone>15 and ARR>20) and was lost to follow up.

Three months later, the patient returned to the ED with dizziness, pre-syncope and weakness. He reported not taking his medications.  BP was elevated (152/103) and serum K 2.8 mEq/L. Random urinary K was 69. Serum aldosterone was 35 and plasma renin 0.14 with ARR 250 (Serum K- 3.1).  An IV saline suppression test failed to suppress the aldosterone (Serum K- 4.2; Aldosterone: pre-test-34, post-test-30; Renin: pre-test- 0.12, post-test- 0.06). He was diagnosed with primary hyperaldosteronism and discharged on only spironolactone 25 mg daily. One week later in the clinic his serum K was 4.4 mEq/L and BP 130/90. He was referred to the surgeon for right adrenalectomy.

Conclusion: As per our literature search, this is the first reported case of intermittent hyperaldosteronism in an adult patient; there is only one published case of a pediatric patient with this entity. (1) In patients with clinical, radiological and laboratory features suggestive of hyperaldosteronism a repeat aldosterone/renin levels might be warranted due to possible intermittent secretion of aldosterone from the adrenal adenoma.


  1. Rogoff D, Bergada I, Venara M, Chemes H, Heinrich JJ, Barontini M. Intermittent hyperaldosteronism in a child due to an adrenal adenoma. Eur J Pediatr. 2001; 160(2): 114-6.

Nothing to Disclose: RS, JGK, ES

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