Unmasking the Silent Culprit: Adrenocortical Carcinoma Revealed through Hypokalemic Periodic Paralysis

Abstract Primary aldosteronism (PA) is an uncommon condition characterized by hypokalemia, hypertension, with or without the presence of an adrenal mass. Diagnosing and managing PA can be particularly challenging in patients who exhibit atypical symptoms. This case of PA in a 41-year-old man who initially presented with acute flaccid quadriparesis, marked by significant limb weakness and difficulty walking. Further investigations revealed that the patient had hypokalemia which was refractory to potassium supplementation. The patient had experienced a similar episode in the past, which had been overlooked as generalized weakness. Imaging studies, including a computed tomography scan of the abdomen, revealed a left adrenal mass. Surgical adrenalectomy was performed, and the diagnosis of adrenocortical carcinoma was confirmed on histopathology. After surgical excision of the mass, his serum potassium levels normalized, and he became asymptomatic, and antihypertensive medicines were stopped.