Hypokalemic periodic paralysis as an atypical presentation of primary hyperparathyroidism: a case report

Abstract

Excess production of parathyroid hormone from a parathyroid adenoma or hyperplasia or carcinoma can lead to hypercalcemia. It produces a wide range of clinical manifestations ranging from abdominal pain to renal calculi. Other electrolyte abnormalities such as hypomagnesemia and hypokalemia are also seen. Complications due to hypokalemia primarily involves the cardiovascular system. Hypokalemic periodic paralysis is an unusual presentation of primary hyperparathyroidism. It presents with acute onset episodes of flaccid paralysis which usually improves following potassium supplementation. We report the case of a 37-year-old male presenting with acute weakness of the extremities with laboratory investigations suggestive of hypercalcemia, hypokalemia, normal anion gaps metabolic acidosis and alkaline urine suggestive of renal tubular acidosis. On further evaluation, the patient was identified to have a right parathyroid adenoma which was managed through surgical excision. Evaluation of secondary endocrine disorders that can lead to hypokalemia is important for early recognition and appropriate management.