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Tohru Eguchi and Shozo Miyauchi


A 43-year-old Japanese woman was admitted to our hospital with weakness. Laboratory findings showed hypokalemia, hypocalcemia and elevation of the serum creatinine phosphokinase levels, but intact parathyroid hormone levels. Further evaluations suggested that she had primary aldosteronism (PA), secondary hyperparathyroidism and bilateral adrenal tumors. She was treated successfully by laparoscopic right adrenalectomy. This case not only serves to the diagnosis of bilateral adrenal tumors in which selective adrenal venous sampling (SAVS) proved to be useful, but also for physicians to be aware of secondary hyperparathyroidism and the risk of secondary osteoporosis caused by PA.

Learning points

  • The classic presenting signs of PA are hypertension and hypokalemia.
  • Hypokalemia can induce rhabdomyolysis.
  • PA causes secondary hyperparathyroidism.
  • Patients with PA have the risk of osteoporosis with secondary hyperparathyroidism.
  • SAVS is useful in bilateral adrenal tumors.