Rhabdomyolysis presenting with severe hypokalemia in hypertensive patients: a case series

BACKGROUND: Rhabdomyolysis presenting with severe hypokalemia as the first manifestation of primary hyperaldosteronism is extremely rare. CASE PRESENTATION: Two middle-aged Chinese females were admitted to our emergency department for muscular weakness and limb pain, and both have the history of early onset hypertension. Laboratory test showed elevated creatinine phosphokinase (4, 907 and 8, 531 IU/L) and extremely low serum potassium (1.38 mmol/L and 1.98 mmol/L). Rhabdomyolysis and severe hypokalemia were established as first diagnosis. Hypokalemic rhabdomyolysis was confirmed after nervous system disorders, autoimmune diseases and trauma were excluded. Adrenal computerized tomography scan and postural stimulation test revealed aldosterone-producing adenomas. They both received laparoscopic adrenalectomy and were stable at the 2-year follow-up visit. CONCLUSION: The two cases remind physicians to bear in mind the risk of hypokalemia-induced rhabdomyolysis among patients with primary hyperaldosteronism.