Stroke disclosing primary aldosteronism: Report on three cases and review of the literature.
OBJECTIVE
There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas.


METHODS
We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke. The diagnosis of primary aldosteronism was established according to the Endocrine Society Clinical Practice Guideline, with a review of the literature on the spectrum of neurologic manifestations in PA.


RESULTS
We report on three cases, two women and a man, presenting with ischemic or hemorrhagic stroke, of early onset in two of them. All of the reported patients had hypertension and hypokaliemia. This association prompted the assessment of renin angiotensin aldosterone system (RAAS) disclosing PA, which was due to bilateral adenomas in the first one or bilateral adrenal hyperplasia in the two others. All patients refused the surgical option and received spironolactone with recurrence of stroke in one of them due to treatment incompliance.


CONCLUSIONS
Although cerebrovascular events are quite common in PA, their occurrence as initial feature can be misleading. The association of hypokaliemia and refractory hypertension in ischemic or hemorrhagic strokes should prompt an assessment of the RAAS to rule out PA and initiate adequate management as soon as possible in order to avoid further complications.
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia. Electronic address: dr.nasri.amina@gmail.com.
Amina
A
Nasri
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Malek
M
Mansour
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Zeineb
Z
Brahem
Department of Medicine, Regional Hospital of Jendouba, Tunisia.
Amel
A
Kacem
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Ahmed Abou
AA
Hassan
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Hager
H
Derbali
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Meriem
M
Messelmani
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Jamel
J
Zaouali
Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
Ridha
R
Mrissa
D000236:Adenoma / Q000150:complications / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis*; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology
Accident vasculaire cérébral; Aldosteronism; Hemorrhage; Hyperaldostéronisme; Hémorragie; Ischemic; Ischémie; Stroke