Endocrine Abstracts

68 years old Caucasian women presented to the emergency department (ED) with complains of stiffness, intolerable pain in lumbosacral region and inability to walk for last two days. The common pain-relieving medications did not subdue her pain. The patient had experienced similar episodes for two years, provoked by remaining in fixed position or after having carbohydrate rich meal. Pain usually persisted for a few minutes and symptoms disappeared after light exercise. Her complains were attributed to lumbar spondylosis and treated with analgesics. Her medical history revealed that she had been admitted to ED due to hypertensive crisis and epistaxis 7 times over last 8 years. She was on maximal dose of perindopril and amlodipine. Further neurological examination revealed asymmetrically decreased strength in lower extremity muscles and asymmetrical proximal leg paraparesis, more pronounced on the left side. Deep tendon reflexes in lower extremity were similar, without pathological reflexes. Sensitivity and the rest of the examinations were normal. Magnetic resonance imaging of the spine ruled out a compressive–expansive condition, CT of the brain showed no relevant changes. Nerve conduction study revealed bilateral carpal canal syndrome dxt > sin, severe grade; sensory-motor polyneuropathy in the legs, axonal-demyelinating; chronic, old L3-L4 sin root damage. BP was 128/80 mmHg. In laboratory tests serum potassium was 3.2 mmol/l, sodium 138.0 mmol/l, creatinine 56.0 µmol/l. ECG showed normal sinus rhythm, heart rate was 70 beats per minute and patient denied any history of dysrhythmias. Due to family history of multiple gastrointestinal cancers, abdominal CT scan with contrast was performed, thus concurrently left side adrenal adenoma of 2 cm in size was detected. The patient was consulted by endocrinologist, plasma aldosterone concentration (PAC) and direct renin concentration (DRC) was assessed. PAC was 9.47 ng/dl, DRC was 0.59 ng/l. PAC/DRC ratio was 15.8 ng/dl/ng/l. According to Endocrine Society Clinical Practice Guidelines 2016 the lowest range of PAC/DRC ratio for diagnosis of primary hyperaldosteronism is 3.8–7.7 ng/dl/ng/l. A council of endocrinologist, endocrine surgeon and radiologist decided to perform left side laparoscopic adrenalectomy. Histopathological examination determined tumour with large compact cells with lipid rich cytoplasm, sign of adrenal cortex clear cell adenoma. After surgery patient improved rapidly with significant reduction of presenting symptoms. She had no further episodes of spine and leg stiffness. We are reporting the unusual case of primary hyperaldosteronism with hypokalemic periodic paralysis mimicking lumbar spondylosis and treated ineffectively with analgesics for several years.