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Medical Resident Research Case Reports

17 A HIGH PRESSURE SITUATION: CONN'S SYNDROME WITH PERIODIC PARALYSIS

Comlavi Tossou, MD; Eric O'Neal, MD; Peng Yin, DO; Kimberly Bird, MD Corresponding author: Comlavi.Tossou@LPNT.net

Sovah Health - Danville, Danville, Virginia

interdisciplinary team and additional imaging if her symptoms persist. Periodic paralysis is an uncommon condition that can be fatal if left untreated, which is primarily hereditary and can be caused by Conn's Syndrome. Surgical intervention is first-line, and patient will need tight blood pressure control with optimal electrolyte control. Diagnosis: Hypertensive emergency, in the setting of Conn's Syndrome, complicated by a history of periodic paralysis Reference: [1] Balhana, S., Pina, H., Machete, M., Aragüés, J., Noronha, C. Conn's Syndrome: An Unusual Cause of Periodic Paralysis. Cureus 2022 May;14(5);e24880

Context: Conn's Syndrome is a phenomenon that involves excessive aldosterone production in the adrenal cortex, which can lead to severe hypokalemia. Report of Case: We present a 32-year-old female who initially presented to the hospital for an acute, progressive onset of nausea, vomiting, and generalized weakness. In addition, there was concern for noncompliance due to the patient's history of multiple hospitalizations at different facilities with similar presentations and multiple muscle spasms. Initial presentation revealed hypertensive emergency, and labs revealed severe hypokalemia, moderate hypomagnesemia, and mild hypophosphatemia. Additional endocrine workup revealed the patient to have Conn's Syndrome. Patient was placed on a nicardipine drip, her electrolytes were repleted, and was restarted on her home antihypertensive regiment: valsartan 160 mg daily, amlodipine 10 mg daily, spironolactone 25 mg daily and clonidine 0.1 mg twice daily. Her spironolactone was increased to 50 mg daily, and she was discharged from the hospital with potassium chloride 40 mEq twice daily.

Comments: An uncommon phenomenon that can be illustrated with Conn's Syndrome is periodic paralysis, a collection of neuromuscular conditions affecting the ion channels of skeletal muscle. A case study described this condition in a patient like the clinical case as mentioned above. Patients can have a wide range of electrolyte abnormalities and will initially present as proximal weakness in the bilateral lower extremities. Periodic paralysis can also cause cardiovascular and gastrointestinal symptoms, which can be fatal if not addressed . Acute episodes can be caused by carbohydrate-rich meals, vigorous physical exercise, trauma, diuretics, insulin, etc. Approximately 1 in 100,000 people are affected, primarily hereditary versus secondary causes. Conn's Syndrome can also cause periodic paralysis and is the second most common endocrinopathy to cause this condition. For our patient, imaging did not reveal any masses the time of admission, but had imaging done in May 2025 which revealed a 2.7 cm mass in the right adrenal gland, unchanged from repeat imaging in August 2025. Surgery is first-line treatment for this condition. The patient will require close follow-up with an

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