[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-455229-105":59,"doc-detail-455229-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","hyperaldosteronism-presenting-as-pre-syncope-a-case-report","Hyperaldosteronism Presenting as Pre-syncope - A Case Report","","Primary aldosteronism (PA) is an often underrecognized cause of secondary hypertension. It is typically linked to hypokalemia, yet profound muscle weakness as an initial symptom is rare, especially without marked electrolyte abnormalities. A 65-year-old man with hypertension and dyslipidemia developed transient episodes of severe weakness and presyncope, with only mild hypokalemia. Evaluation was otherwise unrevealing until endocrine testing confirmed PA, imaging showed adrenal nodules, and adrenalectomy resolved symptoms with five-year follow-up.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hyperaldosteronism-presenting-as-pre-syncope-a-case-report/455229/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hyperaldosteronism-presenting-as-pre-syncope-a-case-report/455229.png","ImageObject",300,407,{"name":92,"@type":93},"A glass of water","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was primary aldosteronism considered in this case despite mild potassium levels?","Question",{"text":112,"@type":113},"Endocrine testing showed suppressed plasma renin activity and elevated plasma aldosterone concentration with a high PAC/PRA ratio, which supported primary aldosteronism even though potassium was only mildly low.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did imaging and adrenal venous sampling show?",{"text":117,"@type":113},"Imaging identified two left adrenal gland nodules consistent with adenomas. Adrenal venous sampling demonstrated left-sided predominance.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was given and what was the outcome after surgery?",{"text":121,"@type":113},"The patient underwent unilateral retroperitoneoscopic adrenalectomy. Symptoms resolved completely, he maintained normotension without antihypertensive therapy, and this persisted through five-year follow-up.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455229,1790957284,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090760832,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Received 05/30/2025  \nReview began 08/26/2025  \nReview ended 11/26/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nMazar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98735  \nOpen Access Case Report  \nPublished via Proceedings of the UCLA Department of Medicine  \nHyperaldosteronism Presenting as Pre-syncope: A Case Report  \nMichael Mazar 1, Ramin Tabibiazar 1, Ravi Dave 1  \n1. Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA Corresponding author: Michael Mazar, [mmazar@mednet.ucla.edu](mmazar@mednet.ucla.edu)  \nAbstract  \nPrimary Aldosteronism (PA) is a common but often underrecognized cause of secondary hypertension. While typically associated with hypokalemia, profound muscle weakness is rarely a presenting symptom, especially in the absence of significant electrolyte derangement. We present a case of a 65-year-old male with hypertension and dyslipidemia who presented with transient acute attacks of profound weakness and presyncope, without loss of consciousness or other focal neurologic signs. Initial evaluation, including cardiac, neurologic, and metabolic testing, was unrevealing. Mild hypokalemia (potassium 3.2 mmol/L) was noted on admission. Further endocrine workup revealed a suppressed plasma renin activity (0 .5  \nng/mL/hr) and elevated plasma aldosterone concentration (28 .3 ng/dL) with a high plasma aldosterone concentration/plasma renin activity (PAC/PRA) ratio (56 .6), suggestive of PA. Imaging identified two left adrenal gland nodules (4 mm and 6 mm) consistent with adenomas, and adrenal venous sampling demonstrated left-sided predominance. The patient underwent a unilateral retroperitoneoscopic adrenalectomy with complete resolution of symptoms. Prior to surgery, he was treated with amlodipine 10 mg daily and prazosin 1 mg twice daily for blood pressure control. Following adrenalectomy, he maintained normotension without antihypertensive therapy, which persisted at five-year follow-up. This case highlightsa rare presentation of PA with episodic severe muscle weakness in the absence of profound hypokalemia. It underscores the importance of considering PA in patients with unexplained episodic weakness and resistant or moderate-to-severe hypertension, even when potassium levels are within normal or mildly low ranges.  \nCategories: Cardiology, Internal Medicine, Endocrinology/Diabetes/Metabolism  \nKeywords: acute flaccid muscle weakness, muscle weakness, pre-syncope, primary hyperaldosteronism, reversible cause of muscle weakness  \nIntroduction  \nPrimary aldosteronism (PA) is a frequently overlooked cause of secondary hypertension, accounting for an estimated 5% to 20% of cases [1] . Although classically associated with hypokalemia, the majority of patients present with normokalemia because compensatory mechanisms (such as increased distal sodium delivery and enhanced potassium secretion) are often balanced by dietary potassium intake and renal adaptation. This can often lead to delayed diagnosis [2] . PA is associated with increased cardiovascular morbidity and poorer quality of life compared to essential hypertension [3] . PA increases cardiovascular risk through mechanisms beyond hypertension, including direct effects of aldosterone on vascular inflammation, endothelial dysfunction, arterial stiffness, and cardiac fibrosis. These changes promote atherosclerosis, arrhythmias (notably atrial fibrillation), and heart failure, independent of blood pressure levels. While neuromuscular manifestations such as muscle weakness are typically observed only in the setting of profound hypokalemia, we present a rare case of PA manifesting as episodic, severe muscle weakness with abrupt loss of postural tone, rendering him unable to stand despite ","cbCainS0LKcXlacT","https://ap.wps.com/l/cbCainS0LKcXlacT","pdf",2648662,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial Evaluation\n## Laboratory Results\n# How to cite this article","[{\"question\":\"Why was primary aldosteronism considered in this case despite mild potassium levels?\",\"answer\":\"Endocrine testing showed suppressed plasma renin activity and elevated plasma aldosterone concentration with a high PAC/PRA ratio, which supported primary aldosteronism even though potassium was only mildly low.\"},{\"question\":\"What did imaging and adrenal venous sampling show?\",\"answer\":\"Imaging identified two left adrenal gland nodules consistent with adenomas. Adrenal venous sampling demonstrated left-sided predominance.\"},{\"question\":\"What treatment was given and what was the outcome after surgery?\",\"answer\":\"The patient underwent unilateral retroperitoneoscopic adrenalectomy. Symptoms resolved completely, he maintained normotension without antihypertensive therapy, and this persisted through five-year follow-up.\"}]","Hyperaldosteronism Presenting as Pre-syncope - A Case Report | PDF",1790742424,15]