A Diagnostic Pitfall of Primary Aldosteronism Presenting as Recurrent Quadriparesis: A Case Report

Quadriparesis refers to weakness affecting all four limbs. While most cases are neurogenic in origin, stemming from central or peripheral nervous system pathology, non-neurogenic causes are less common and often under-recognized. These include systemic or metabolic conditions that secondarily impair neuromuscular function. A 37-year-old woman experienced intermittent episodes of quadriparesis over 2 years. Despite multiple medical evaluations, her symptoms were repeatedly attributed to generalized weakness, leading to delayed diagnosis and ineffective treatment. Comprehensive diagnostic workup revealed persistent hypokalemia of 3.2-3.4 and a lowest recorded value of 2.1 mmol/L with elevated aldosterone levels, that is, 100 ng/dL and suppressed renin activity, consistent with primary aldosteronism. Cross-sectional imaging identified a right adrenal adenoma. The patient underwent successful laparoscopic adrenalectomy and was discharged in stable condition within 1 week. On follow-up, she demonstrated complete resolution of symptoms and normalization of serum potassium levels. This case illustrates an uncommon presentation of primary aldosteronism manifesting as recurrent quadriparesis and highlights the importance of considering endocrine and metabolic etiologies in patients with episodic or unexplained limb weakness. Early recognition of potentially reversible causes, along with a multidisciplinary approach involving endocrinology, radiology, and surgery, may facilitate timely diagnosis and favorable clinical outcomes. Clinicians should consider non-neurogenic causes of quadriparesis, particularly in patients presenting with hypokalemia or resistant hypertension, even when classic endocrine features are not prominent.