Hypokalemic Paralysis in a Young Woman with Thyrotoxicosis and Primary Aldosteronism

Wan-Ni Tsai ； Shih-Yi Lin ； Lien-Nien Tseng ； Wayne H-H Sheu

《Formosan Journal of Endocrinology and Metabolism》 1卷5期 (2010/10) Pp. 19-22

https://doi.org/10.6856/FJEM.201010_1(5).0005

摘要

Hypokalemic paralysis with simultaneous hyperthyroidism and primary hyperaldosteronism has rarely been reported previously. We present a case of a thyrotoxic 27-year-old woman with hypokalemic paralysis and an aldosterone-producing adenoma. A 27-year-old woman presented with episodic muscle weakness, palpitation, and high blood pressure for two months. Laboratory investigation showed severe hypokalemia and primary hyperthyroidism. Although the patient was initially treated with propylthiouracil and potassium chloride, she suffered from proximal muscle weakness and persistent hypokalemia. Further endocrinological examinations demonstrated that 24-hour urinary potassium excretion was increased with a high transtubular potassium gradient, indicating a profound urinary potassium loss. Primary aldosteronism was suspected due to a suppressed plasma renin concentration and a high plasma aldosterone concentration. Abdominal computerized tomography revealed a poor enhanced mass about 32 mm in size at the left adrenal gland. Left adrenectomy was performed under suspicion of aldosterone-producing adenoma. The pathology proved to be an adrenal cortical adenoma. Postoperatively, serum potassium level returned to normal with no recurrence of muscle weakness. It is therefore suggested that other causes of hypokalemic paralysis in addition to thyrotoxic periodic paralysis should be considered in thyrotoxic patients with muscle weakness, particularly in association with persistent hypokalemia, hypertension, and abnormally high potassium renal excretion.

關鍵字

hypokalemic paralysis ； thyrotoxicosis ； primary aldosteronism ； Graves' disease ； aldosterone-producing adenoma