Primary aldosteronism presented with intracranial hemorrhage

Although primary aldosteronism (PA) has been reported as a relatively benign form of hypertension and is associated with low incidence of vascular complications, recent reports indicate that PA complicated by cerebral vascular accidents is not rare. The authors reported here that a 57-year-old man was diagnosed as a case of PA 4 years after initial treatment of intracerebral hemorrhage (ICH) and hypertension. The patient was transferred to our department for further management of his left hemiplegia and hypertension after surgical treatment for a putaminal ICH at the age of 53. During the first 2 years of follow-up, he did well except for an episode of transient motor weakness. Diastolic hypertension was moderately good, controlled by calcium antagonists and ACE inhibitors. Laboratory data was normal, and the serum potassium levels were in the lower limits of normal. In the last 2 years, episodes of motor weakness have increased. He was admitted to our hospital, under the suspicion of recurrent Todd's paralysis. The serum potassium level ranged from 1.9 to 2.1 despite administration of potassium agents. Abdominal CT scans and 131 I-scintigraphy disclosed a left adrenal tumor. Elevation of plasma aldosterone and suppression of plasma renin were observed. The diagnosis of PA due to hypersecretion of aldosterone from an adrenal tumor was thus confirmed. We performed a total left adrenectomy 4 weeks after his admission. Histological examination showed a clear-cell type of benign adrenal adenoma. After the operation, laboratory data were normal and ACE inhibitors were able to normalize his diastolic hypertension. According to the literature, PA complicated by ICH is associated with a high rate of recurrence of cerebral vascular accidents if treatment of PA is not performed. Although diagnosis of PA in the early stage is difficult, as it was in our presented case, high suspicion of PA is essential for patients with diastolic hypertension and persistent hypopotassiumemia, particularly in young adults and middle-aged patients.