Primary Aldosteronism in General Practice: Timely Diagnosis as a Key to Problem Solving

Objective. The aim of the study is to demonstrate the clinical significance of the timely detection of secondary hypertension in patients with resistant hypertension and severe cardiovascular complications. Materials and Methods. We analyzed a clinical case of a 49-year-old female patient with long-standing resistant hypertension, multiple ischemic strokes, severe hypokalemia, and target organ damage. Clinical and laboratory evaluations were performed, including measurements of aldosterone and renin levels and the aldosterone-to-renin ratio (ARR). Adrenal imaging was conducted using computed tomography (CT). Results. The patient presented with persistent, poorly controlled hypertension despite multicomponent antihypertensive therapy, chronic severe hypokalemia. Notably, this hypokalemia had long been overlooked and had not prompted either a treatment revision or a targeted diagnostic workup. Additionally, hypernatremia, left ventricular hypertrophy, and sequelae of recurrent ischemic strokes were identified. Hormonal profiling revealed elevated aldosterone levels and an increased aldosterone-to-renin ratio. Computed tomography identified a left adrenal mass consistent with an aldosterone-producing adenoma. The patient underwent endoscopic left adrenalectomy. Postoperative outcomes included normalization of potassium levels, a decrease in aldosterone concentration, restoration of the aldosterone-to-renin ratio, and achievement of target blood pressure levels. It is highly probable that the prolonged, undiagnosed course of primary hyperaldosteronism was a major risk factor for the recurrent acute cerebrovascular events that resulted in the patient's permanent disability. Conclusion. This case highlights a prolonged, undiagnosed course of primary hyperaldosteronism associated with severe cerebrovascular complications and subsequent disability. In routine clinical practice, timely screening for primary hyperaldosteronism using the aldosterone-to-renin ratio in comorbid patients with resistant hypertension and hypokalemia could facilitate early diagnosis and ultimately improve patient outcomes.