200 Section - Silent Culprit Unmasked: The Overlooked Role of Primary Hyperaldosteronism in a Young Woman’s Hemorrhagic Stroke

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

KE

Kiyana Ellison, DO/OMS-IV

Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States
KH

Karam M. Hamada, MD

Physiatry Resident
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Co-Author/Coautor(s)

WB

William Bridges, MD

Attending Physiatrist
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Case Diagnosis: Primary hyperaldosteronism is an underdiagnosed and crucial cause of secondary hypertension with an associated increased risk of cerebrovascular complications. With the rising rates of stroke in young adults, the differential for refractory hypertension in the inpatient rehabilitation setting should include working up for hyperaldosteronism.

Case Description: A 34-year-old female with a history of uncontrolled hypertension on multiple antihypertensives and a maternal history of early-onset stroke in her 30s presented to the acute hospital with acute dysarthria, gait instability, and severe left hemiparesis. Imaging revealed a basal ganglia intracranial hemorrhage. Patient was admitted to a brain injury unit in an inpatient rehabilitation hospital. Rehab stay was complicated by recurrent hypokalemia despite repletion and difficulty controlling hypertension with associated headaches. Aldosterone to renin ratio (ARR) and plasma aldosterone concentration (PAC) were markedly elevated. The patient was started on Spironolactone with significant improvements in symptoms, blood pressure and hypokalemia by time of discharge. CT of the Abdomen did not reveal any obvious adrenal pathology. She was set up for endocrinology follow-up for further testing and genetic evaluation for familial hyperaldosteronism.

Discussions: Primary Hyperaldosteronism is now recognized as one of the most common and potentially treatable etiologies, accounting for up to 12% of hypertensive patients and a higher proportion among those with resistant hypertension. These diagnoses can be identified during the inpatient rehab stay as the patient transitions back to the community. Early diagnosis and intervention can prevent recurrent cerebrovascular events and improve long-term functional outcomes. Connecting these patients with genetic testing and endocrinology follow-up are essential for definitive diagnosis and management.

Conclusions: This case emphasizes the importance of routine screening, early diagnosis and management for primary hyperaldosteronism in young adults with refractory hypertension. Physiatrists should maintain a low threshold for screening when indicated during the inpatient rehabilitation stay as these may be overlooked following acute hospitalization.