Selective Hypoaldosteronism with Hyperkalemia

A 59-year-old diabetic woman with moderate renal insufficiency had unexplained hyperkalemia, aggravated by sodium restriction and corrected with desoxycorticosterone acetate (Doca®) administration. Urinary aldosterone excretion was low and failed to increase despite several stimuli to its release; glucocorticoid excretion and response to adrenocorticotropic hormone stimulation were normal. Plasma renin activity in this patient was undetectable even after volume depletion and weight loss. We conclude that selective hypoaldosteronism in this case, unlike other reported cases, was caused by inadequate adrenal stimulation from the renin angiotensin system.