Severe hypokalaemia in primary aldosteronism during pregnancy

Primary aldosteronism (PA) is rarely seen in pregnancy despite being a common cause of secondary hypertension. Spironolactone, the first-line treatment, is contraindicated in pregnancy due to potential anti-androgenic effects; treatment options are thus limited. We present a case in which severe hypokalaemia associated with PA was discovered during pregnancy. Eplerenone was used as a short-term treatment without adverse effects to the fetus before unilateral laparoscopic adrenalectomy was performed in the second trimester after the patient was refractory to medical treatment. This case report adds to the limited literature on management of PA in pregnancy, which could influence future risk-benefit discussions regarding surgical versus medical management of this condition.