Renal unmasking postadrenalectomy: From hypokalemia to hyperkalemia in primary hyperaldosteronism

Abstract This case highlights a patient who was evaluated for hypertension, hypokalemia, and metabolic alkalosis. Subsequently, she was diagnosed with an adrenal adenoma and underwent laparoscopic adrenalectomy. Her renal function was normal before the procedure. However, on follow-up, she was found to have gradually increasing creatinine levels, along with a shift from hypokalemia to hyperkalemia. Imaging studies also showed the presence of medullary nephrocalcinosis. The shift from hypokalemia to hyperkalemia is due to chronic suppression of the renin–aldosterone axis of the contralateral adrenal gland. Patients with primary hyperaldosteronism experience a state of hyperfiltration, which masks underlying renal dysfunction. The unmasking of renal dysfunction occurs postprocedure and was responsible for the renal issues observed. Chronic hypokalemia leading to tubular interstitial injury or kaliopenic nephropathy was the underlying cause of medullary nephrocalcinosis in this case. This case report highlights the importance of understanding renal dynamics in patients with primary hyperaldosteronism who have undergone adrenalectomy.