Rhabdomyolysis as a dangerous complication of primary hyperaldosteronism

Rhabdomyolysis is a rare, dangerous complication of primary hyperaldosteronism (PHA) induced by hypokalemia. PHA is underdiagnosed because it does not have a specific, easily identifiable feature and clinicians can be poorly aware of the disease. Prompt diagnosis of PHA and the use of targeted treatment strategies mitigate aldosterone-specific target organ damage, such as rhabdomyolysis. Progressive muscle weakness, as the main symptom of the development of muscle damage, is a reason to monitor electrolyte balance. We present a detailed description of two cases of rhabdomyolysis with hypokalemia. Patient 1, 45 y.o., with an increase in blood pressure (BP) to 220/120 mmHg, which could not be corrected against the background of 3-component antihypertensive therapy, with complaints of headaches, dizziness, sweating, severe muscle weakness of the extremities, muscle pain, was acutely admitted to the hospital, where creatine phosphokinase (CPK) 17204 IU/l (up to 145), CPKMB 205 IU/L (up to 24), AST 889 U/L (up to 35), ALT 232 U/L (up to 40), blood potassium 2.0 mmol/L (3.3–5.5). Neurologist, rheumatologist excluded pathology. Aldosteroma of the right adrenal gland was detected with normalization of BP and potassium levels after adrenalectomy. Patient 2, 55 y.o., with an increased BP of 200/110 mmHg, general and muscular weakness, severe pain in the muscles and joints of the extremities, shortness of breath during physical exertion, heart arrhythmia, was observed for 6 years by a cardiologist, neurologist, rheumatologist, with repeated hospitalizations, including for about rhabdomyolysis. Despite recurrent hypokalemia, the adrenal gland examination was performed only after consultation with an endocrinologist due to loss of consciousness in case of hypoglycemia. The examination revealed primary hyperparathyroidism, bilateral PHA, non-toxic nodular goiter, pituitary microadenoma. Hypoglycemia was not achieved in the 72-hour fasting trial. Multiple endocrine neoplasia type 1 syndrome has been established clinically. In the available literature in Russian and in English, we have found the description of less than 40 similar case reports. A detailed description of those cases is also provided.

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