recurrent hypokalemia in primary aldosteronism: a case report

Primary hyperaldosteronism (pa), or conn’s syndrome, is a common yet underdiagnosed cause of secondary hypertension. it is characterized by excessive aldosterone secretion leading to hypokalemia, metabolic alkalosis, and treatment-resistant hypertension. this condition often presents with subtle clinical signs, making timely diagnosis crucial to preventing cardiovascular and renal complications. the case of a 24-year-old woman  is reported in this study with recurrent headaches, resistant hypertension, and chronic constipation. her blood pressure remained uncontrolled despite multiple antihypertensive medications. laboratory investigations revealed persistent hypokalemia, suppressed renin, and elevated aldosterone levels. imaging studies demonstrated a right adrenal mass consistent with an aldosterone-producing adenoma. the patient underwent successful unilateral adrenalectomy. postoperatively, her blood pressure and serum potassium normalized, and histopathological examination confirmed an adrenocortical adenoma. this case underscores the importance of evaluating secondary causes in young patients with resistant hypertension and hypokalemia. aldosterone excess increases sodium reabsorption and potassium excretion, contributing to volume expansion and hypokalemia. this electrolyte imbalance can lead to gastrointestinal symptoms such as constipation, as seen in our patient. early recognition and targeted treatment—either surgical or medical—can significantly improve outcomes. in this case, adrenalectomy led to resolution of symptoms and normalization of biochemical parameters, eliminating the need for long-term potassium supplementation or multiple antihypertensives. primary hyperaldosteronism should be considered in patients with refractory hypertension and spontaneous hypokalemia. early diagnosis and appropriate intervention, such as adrenalectomy for unilateral disease, can restore electrolyte balance and improve blood pressure control, thus preventing long-term complications.