Undiagnosed primary hyperaldosteronism: impacts on progression to end-stage renal disease

Abstract

Introduction: Primary hyperaldosteronism (PHA) is a frequent but underdiagnosed cause of secondary hypertension. Early identification is crucial to prevent severe outcomes such as end-stage renal disease (ESRD). Case report: A 28 year-old female with refractory hypertension since age 22 progressed to ESRD without previous investigation for secondary causes. After hospitalization with severe renal dysfunction and suggestive clinical signs, PHA was diagnosed based on an elevated aldosterone-to-renin ratio. Treatment with spironolactone led to adequate blood pressure control, but renal function did not recover. Discussion: This case highlights the importance of early screening for PHA in young patients with resistant hypertension, as timely treatment may prevent irreversible complications
like ESRD. Conclusion: A delayed diagnosis of PHA can lead to severe and irreversible morbidity. Early detection strategies should be emphasized, particularly in high-risk groups.