From Epidural Hematoma to the Diagnosis of Primary Hyperaldosteronism: A Clinical Challenge. Case Report

Primary hyperaldosteronism (PAH) is defined as a syndrome in which increased and autonomous aldosterone secretion originates from the adrenal gland. PAH is understood from a physiological perspective, where aldosterone regulatory mechanisms are unable to limit its various effects and clinical manifestations resulting from its ectopic overproduction. In the absence of angiotensin II, proximal tubular sodium reabsorption decreases, inducing a high flow of urine and sodium to the aldosterone-sensitive distal nephron. This induces an increase in sodium reabsorption mediated by epithelial sodium channels, resulting in secondary arterial hypertension. Several mutations, such as KCNJ5, present in adrenal adenomas that lead to PAH, have been identified. The case of a patient diagnosed with resistant arterial hypertension is presented. It is essential to consider other etiologies of secondary arterial hypertension. He was sent to the hospital floor where he presented neurological symptoms related to headache and drowsiness, remaining awake, without symptoms of intracranial hypertension or paresis in any body segment. It was decided to expand complementary studies due to suspicion of secondary arterial hypertension, with abdominal and pelvic tomography with bilateral adrenal growth, predominantly on the left side. Right testicle with approximate dimensions of 67X53MM, as a probable primary neoplasia. Testicular tumors occur mainly in patients with congenital adrenal hyperplasia, one of the most common congenital adrenal diseases, it belongs to the autosomal disorders of the adrenal cortex receptors that affect the production of adrenal steroids and is caused by a defect in one of the enzymes involved in adrenal steroidogenesis. The above was considered in our patient, however, the diagnosis was not completed because he refused to undergo oophorectomy or biopsy to determine the histology of the tumor. The importance of suspecting secondary causes of high blood pressure, regardless of the patient's initial diagnosis, is to perform the necessary diagnostic tests to confirm or rule out a diagnosis.