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Abstract: TH-PO381

The Dual Diagnosis: Hypokalemic Rhabdomyolysis Unveils an Adrenal Nodule

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Bhan, Ahana, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Taher, Mohamed, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Kalra, Kartik, Geisinger Medical Center, Danville, Pennsylvania, United States
Introduction


The occurrence of rhabdomyolysis as the initial manifestation of primary hyperaldosteronism (PHA), accompanied by severe hypokalemia is uncommon. We present a distinctive case where a patient with hypertension experiences myalgia,revealing severe hypokalemia causing rhabdomyolysis,ultimately leading to the identification of adrenal nodule.

Case Description

61 year old female with past medical history of hypertension presented to the hospital evaluation of weakness and myalgias ongoing for 2 weeks.She denied drug abuse, diuretics or liquorice use. No significant family history. Blood pressure (BP) 165/102 mm Hg and tenderness to palpation of thighs bilaterally. Labwork (table 1) revealed Hypokalemia and elevated CK levels. EKG demonstrated elongated QT interval and U wave. Rhabdomyolyis and severe Hypokalemia were established as first diagnosis.She was treated with supplemental IV/oral potassium and fluids. Labs (Table 1) suggested low plasma renin activity (PRA) and elevated Aldosterone/PRA ratio raising suspicion for PHA. Patient was started on amlodipine,telmisartan,aldactone with oral potassium. A CT adrenal protocol revealed 2 cm right adrenal nodule,possibly an aldosteronoma. Patient was referred for lapraroscopic adrenelectomy.

Discussion

Severe hypokalemia (potassium < 2.0 mmol/L),can lead to decreased blood flow and muscle perfusion,triggering rhabdomyolysis. While there are limited documented cases in the literature, PHA has been identified as a potential cause of hypokalemia-induced rhabdomyolysis. Other factors associated with this condition include licorice ingestion,laxative abuse,and diuretic use. Diagnosing PHA can be challenging when rhabdomyolysis and severe hypokalemia manifest as initial symptoms. A high level of suspicion is crucial in hypertensive patients,where the occurrence of rhabdomyolysis and hypokalemia necessitates considering primary hyperaldosteronism as a potential cause.