FEATURE: CORINNE I. ALOIS, MS, PA-C; ALYSSA C. QUINLAN, PA-C, MPAS
Clinical Challenge: An Underdiagnosed Cause of Resistant Hypertension Once thought to be rare, the prevalence of primary aldosteronism is estimated to be 5% to 17%, although the condition remains underdiagnosed.
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A
30-year-old woman presents to the emergency department (ED) with headache, nausea, vomiting, diarrhea, and abdominal pain that started 1 day ago. The patient reports 3 episodes of nonbilious, nonbloody vomiting with concomitant bilateral extremity weakness lasting about 15 minutes and 2 episodes of nonbloody diarrhea. She reports intermittent episodes of generalized body aches and lower extremity weakness over the last 2 months. She denies fevers, chills, weight loss, neck pain, shortness of breath, palpitations, chest pain, or paresthesias. The patient has a medical history of hypertension for 3 years and type 2 diabetes for 4 years. She has been noncompliant with medications for these conditions for the last 6 months because of insurance issues. It is not known whether she was screened for a secondary cause of hypertension when she initially began treatment. Her family history is noncontributory. She denies smoking as well as alcohol or drug use. She is a married stay-at-home mom with 2 daughters. She denies a history of gestational hypertension or preeclampsia but had a spontaneous abortion at 9 weeks’ gestation within the last year.The patient reports possible recent influenza exposure and is anxious that something is wrong. Up to 10% of patients with hypertension have aldosteronism.
Physical Examination
On arrival, her vitals are as follows: blood pressure, 195/126 mm Hg; respiratory rate, 18 breaths per www.ClinicalAdvisor.com • THE CLINICAL ADVISOR • JULY/AUGUST 2021 35
