HYPOKALAEMIA AND COMORBIDITIES ARE COMMON AT INITIAL PRESENTATION IN PATIENTS WITH PRIMARY HYPERALDOSTERONISM

Abstract

OBJECTIVES

Primary hyperaldosteronism (PH) is the most common endocrine cause of hypertension (HTN) and is associated with end organ damage. About 30% of cases present with hypokalemia. Studies on the presentation of PH among the Indian population is lacking. This study evaluated the presenting characteristics of patients with PH from Eastern India.

METHODOLOGY

This  is  a  retrospective  study  that  included  Saline Suppression Test (SST) confirmed PH patients.

RESULTS

The study involved seventy-eight confirmed PH patients with mean age of 55 ± 13 years and male-to-female ratio of 1.5:1. Mean duration of HTN was 13.3 ± 7.6 years and 62% had HTN more than 10 years. Mean SBP and DBP was 165.1 ± 13.5 mm Hg and 96.2±14.4 mm Hg, respectively. The mean number of anti-hypertensive medications was 3 ± 0.7. Majority presented with hypertension and hypokalemia (78%), 52% of which were spontaneous while 26% were diuretic-induced. About 14% presented with resistant HTN and 8% with adrenal incidentaloma. Overall, 64% of subjects had resistant HTN. Approximately 16.7% of patients experienced hypokalemic periodic paralysis. Mean serum sodium and potassium levels were 139.4 ± 2.3 mmol/l and 3.08 ± 0.6 mmol/l, respectively. Mean eGFR was 71.8± 20.8 ml/min/1.73 m², with 39.7% having Stage 3 CKD. Majority (95%) had comorbidities from end organ damages, with 43% having multiple comorbidities.

CONCLUSION

Our study revealed a high proportion of hypokalemia and resistant hypertension at detection of PH suggesting delayed diagnosis. A significant number of patients had comorbid illnesses due to end organ damage at presentation, highlighting the need for awareness, early screening and appropriate management of PH.