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Primary aldosteronism (PA) is a significant yet often overlooked cause of secondary hypertension. Early diagnosis and targeted treatment are essential to mitigate long-term cardiovascular risks. This case series examines the clinical characteristics and management of PA patients at Hospital Sultan Abdul Halim, Kedah.
To describe the clinical presentation, diagnostic modalities, and treatment outcomes of patients diagnosed with PA in our tertiary referral center.
We conducted a retrospective review of eight patients diagnosed with PA between 2022 and 2024. Data extracted from medical records included demographics, clinical features, biochemical parameters (aldosterone-renin ratio (ARR)), confirmatory tests, imaging findings, treatment strategies, and clinical outcomes.
The median age at PA diagnosis was 50.5 years (range 34-73), with a median duration of 6 years (range 2-16) from hypertension onset to PA diagnosis. All patients presented with resistant hypertension, six with hypokalemia, and two with adrenal incidentalomas. ARR was elevated in all cases, with non-suppression on confirmatory testing in six patients. Two patients had a history of repeated hypokalemia without further investigation. Adrenal imaging revealed adenomas in seven cases. Adrenal venous sampling (AVS) was performed in four, confirming lateralization in two. Two patients underwent adrenalectomy, resulting in minimal or no antihypertensive medication requirement. Four patients refused surgery and were managed with mineralocorticoid receptor antagonists (MRA). One patient succumbed to end-stage renal failure (ESRF) complications before definitive PA treatment, and one defaulted follow-up post-referral for surgery.
This case series highlights the diverse clinical presentations of PA, including resistant hypertension and hypokalemia. Delays in diagnosis, as evidenced by the repeated hypokalemia without investigation, underscore the need for increased awareness. Adrenalectomy demonstrated excellent outcomes in selected patients, while MRA therapy effectively control blood pressure among others who declined surgery.
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